Bloodletting for Peripheral Artery Disease?

In the bad old days, bloodletting and leeching were used to reduce the amount of blood in the body; this was supposed to cure many ills, but it fell into disuse with the development of more modern approaches. When I was in medical school (1950-56) the pharmacy department had a small collection of leeches that the professor would bring out once a year to help keep us awake. Well, whatever’s old is new again.

Actually, leeches have been recently approved by the FDA to help in some types of skin grafting and surgical wound repair. And removal of varying amounts of blood (by a needle in a vein) has been used to treat hemochromatosis and polycythemia (two blood diseases associated with the presence of too much iron or too many red cells in the blood).

Recently a theory was put forward that peripheral artery disease (PAD), which is a common and serious cardiovascular disease associated with atherosclerosis, might be related to too much iron in the blood. And the use of bloodletting (phlebotomy) was proposed as a way to reduce iron stores in the body. A well-designed clinical study of twice-yearly bloodletting in 1,270 patients with PAD has reported that, although ferritin was reduced, there was no significant improvement in the all-cause or cardiac death rate, or cardiovascular events, like heart attack or stroke. Oh well, back to the drawing board.