Temporary spinal cord stimulation for peripheral cholesterol embolism.
Cholesterol embolism is often an unrecognized complication of some cardiac and vascular procedures (i.e. coronarography, angioplasty, aortocoronary bypass, abdominal aortic aneurysmectomy) and of therapies affecting coagulation (thrombolysis, anticoagulation). The degree of pain associated with ischaemic and necrotic lesions secondary to cholesterol embolism involving the lower limbs is disproportionate to the extension of tissue involvement. Spinal cord stimulation (SCS) has been recognized as effective in relief of pain of ischaemic and neuropathic nature, although its mechanism of action is still not completely clear. The authors are unaware of previous reports of peripheral cholesterol embolism treated by SCS. Two case reports of inferior limb ischaemia secondary to cholesterol embolism in patients who had undergone cardiac invasive procedures. Temporary surgical implantation of SCS devices, which were removed after 4 to 6 weeks. Pain relief was achieved within 1 to 4 hours of surgical procedure. Any analgesic medications could be immediately discontinued. Pain control was effective and normal daily activities were rapidly regained. Ischaemic lesions healed within 4 to 6 weeks of SCS. Pain control is the most critical aspect of the management of peripheral cholesterol embolism without visceral organ involvement. SCS provided effective pain relief in the reported cases and its established ability to improve peripheral microcirculation allowed rapid resolution of necrotic lesions. Temporary SCS should be considered in the management of painful necrotic skin lesions secondary to iatrogenic cholesterol embolism.
Ghilardi
G
G
Department of General Surgery, Insitute of Medicine, Surgery and Dentistry, S. Paolo Hospital, University of Milan, Milan, Italy. giorgio.ghilardi@unimi.it
Massaro
F
F
Gobatti
D
D
Kunkl
E
E
Scorza
R
R
D015360:Analgesia, Epidural; D018438:Blue Toe Syndrome / Q000209:etiology / Q000628:therapy; D004599:Electric Stimulation Therapy; D017700:Embolism, Cholesterol / Q000150:complications / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D011183:Postoperative Complications; D013116:Spinal Cord; D013997:Time Factors