Epidural spinal cord stimulation in the treatment of severe peripheral arterial occlusive disease.
Epidural spinal cord stimulation (ESCS) has been suggested to improve microcirculatory blood flow and reduce amputation rates in patients with severe peripheral arterial occlusive disease (PAOD). Pain relief, limb salvage, and skin circulation were studied in 177 patients with ischemic pain caused by nonreconstructible PAOD who were receiving ESCS. Medical or surgical therapy had failed and vascular reconstruction was impossible in all cases. Clinical status was classified as Fontaine's stage III (chronic ischemic rest pain) in 114 patients and Fontaine's stage IV (ischemic pain and ulcers or dry gangrene) in 63 patients. PAOD was essentially due to arteriosclerosis, but 36 patients also had diabetic vascular disease. After a mean follow-up of 35.6 months, significant pain relief (> 75%) with limb salvage was achieved in 110 patients. In 11 patients with limb salvage, pain alleviation was determined to be between 50% and 70%. ESCS was ineffective in reducing pain, leading to major amputation in 56 patients. The cumulative limb salvage rate was 66% at 4 years. The systolic ankle/brachial blood pressure index did not change under stimulation. TcPO2 was assessed on the dorsum of the foot. Clinical improvement was associated with increased TcPO2, with limb salvage improving from 24.2 to 48.1 mm Hg in stage III (p < 0.02) and from 16.4 to 37.2 mm Hg in stage IV (p < 0.03) disease. A TcPO2 increase of more than 50% within the first 3 months after implantation was predictive of success. TcPO2 changes are correlated with the presence of adequate paresthesias in the painful area during the trial period.(ABSTRACT TRUNCATED AT 250 WORDS)
Horsch
S
S
Department of General and Vascular Surgery, Academic Teaching Hospital, Cologne-Porz, Germany.
Claeys
L
L
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D005734:Gangrene; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D007871:Leg Ulcer / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010092:Oximetry; D059408:Pain Management; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply; D013116:Spinal Cord / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome