Résumé
Peripheral venous access (PVA) is recommended as the first-line vascular approach for therapeutic plasmapheresis with centrifugation methods, but not filtration wich usually requires high blood flow. We evaluated the feasibility, performance, and safety of double filtration plasmapheresis (DFPP) with peripheral venous access, using ultrasound guidance and regional citrate anticoagulation (RCA), in patients treated with chronic DFPP. Secondly, we assessed the number of central venous catheters (CVCs) avoided.Method: 22 adult patients treated with chronic DFPP were evaluated for performing PVA-DFPP. They were classified into 3 groups: success (i.e. completion of sessions with PVA), primary failure 28 (i.e. no session completed), secondary failure (i.e. ≥1 session completed with PVA but secondary return with CVC or arteriovenous fistula (AVF)).Results: among the 22 patients included (64% men), 7 (32%) patients were classified as primary failure (2 patient refusal, 5 inadequate peripheral venous access), 1 (5%) patient as secondary failure (patient choice), and 14 (64%) patients as success for the following diseases: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) (12 patients) and Familial Hypercholesterolemia (FH) (2 patients). 116 sessions were performed in the 14 treated patients, with a median treated plasma volume of 4.3L [3.6; 4.6] for a median duration of 134 minutes [122; 144], and a median blood flow of 94 ml/min [87; 103]. LDL-cholesterol reduction was -74% [-78; -70] for the 2 FH patients. 11/116 (9%) session interruptions occurred, mostly for PVA dysfunction (5/11 i.e. 45%), then for circuit clotting (4/11 i.e. 36%). Session interruptions decreased significantly between each patient’s first and following sessions (from 29% to 7%, p=0.009). Finally, CVC or AVF was avoided in the whole "success" group.Conclusion: chronic DFPP with PVA and RCA can be performed with good efficiency and safety, and avoids the use of CVC. It is conditioned by the peripheral venous capital and requires a trained care team.