Lipid-apheresis (LA) and LDL-apheresis (LDLa) are extracorporeal techniques which permit the unselective or specific removal of lipids and lipoproteins, namely Low Density Lipoproteins (LDL), as well as other apolipoprotein B100 (apoB)-containing lipoproteins from plasma -Intermediate Density Lipoproteins, Lipoprotein(a)- [IDL, Lp(a)]. LDLa represents a selective upgrading (with both clinical and metabolic advantages) from conventional forms of extracorporeal therapy such as plasma-exchange (PEX) used in the seventies to treat severe hypercholesterolaemia. The primary reason to use LDLa is the treatment of homo-, double- (compound), and heterozygous familial hypercholesterolaemia (Hoz- DHtz- Htz FH). This technique also been shown efficacious in the treatment of other severe forms of hyperlipoproteinemia such as Autosomal Recessive Familial Hypercholesterolaemia, HyperLp(a)lipoproteinemia, Familial Combined Hyperlipoproteinemia, and other lipid metabolism disturbances associated with an elevated cardiovascular risk (CVR) when used on patients who are poor- or non-responders to pharmacological treatment following specific guidelines for the reduction of cholesterol in plasma. Patients with these severe forms of dyslipidemia and, particularly, those affected by FH are subject to coronary ischemic events and thus require an intensive, efficacious, constant, continuous, and personalized form of therapy. A therapy based solely on pharmacological drugs does not achieve the desired results in the Hoz- and DHtz forms of FH as well as in approximately 15-20% of the Htz form. In the aforementioned clinical conditions LDLa treatment offers a necessary therapeutic approach. LDLa can also be applied in the prevention of secondary recurrence of coronary ischemic events and of arterial stenosis which can appear rather frequently post-vascular surgery (coronary by-pass, percutaneous transluminal angioplasty). Emerging indications, the effects of LDLa on inflammatory parameters, and the future role of LDLa with regard to the novel potent lipid-lowering drugs are under investigation.