title: The role of epidural spinal cord stimulation in the treatment of Buerger's disease.
abstract: OBJECTIVE
  This clinical, retrospective study is evaluated the effect of epidural spinal cord stimulation (SCS) in the treatment of Buerger's disease.
  
  
  METHODS
  The clinical criteria of Shionoya were used to diagnose 29 patients (22 men, 7 women; mean age 33.7 years) with Buerger's disease. The patients underwent SCS. Complete physical examination and vascular laboratory data were available and recorded for all patients. Questions regarding the improvement of symptoms, in lifestyle, and in physical activities were asked direct interview or by telephone during mean follow-up of 4 years.
  
  
  RESULTS
  The regional perfusion index (RPI), the ratio between the foot and chest transcutaneous oxygen pressure at baseline (before SCS treatment) was 0.27 +/- 0.25. Three months after SCS implantation the RPI increased to 0.41 +/- 0.22. During the follow-up period, a sustained improvement in microcirculation was recorded: the RPI at 1-year follow-up was 0.49 +/- 0.34 and at 3-year follow-up was 0.52 +/- 0.21. The most pronounced improvement in the RPI values was found in the subgroup of 13 patients with trophic lesions. In this group, the RPI increased significantly from 0.17 +/- 0.21 to 0.4 +/- 0.18 (P < .023) after a mean follow-up of 5.7 years. Two patients underwent major amputation of the lower target limb. The limb survival rate was 93.1%. During the follow-up period of 4 years, 21 of the 29 patients continued to smoke, and only five patients stopped nicotine exposure.
  
  
  CONCLUSIONS
  We recorded a significant benefit in the microcirculation, a good limb survival rate, and the absence of new trophic lesions. During the follow-up period, no severe complications related to the implanted devices occurred. Because of the diffuse, distal, segmental nature of the disease, SCS should be considered as an alternative treatment modality in patients with Buerger's disease.
authors.affiliation: Department of Vascular Surgery, Hospital Porz am Rhein, Academic Teaching Hospital of the University of Cologne, 51149 Cologne, Germany.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.forename: Stefan
authors.initials: S
authors.lastname: Schulte
authors.forename: Kiriakos
authors.initials: K
authors.lastname: Ktenidis
authors.forename: Svante
authors.initials: S
authors.lastname: Horsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001785:Blood Gas Monitoring, Transcutaneous; D004599:Electric Stimulation Therapy / Q000379:methods*; D004824:Epidural Space; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D013919:Thromboangiitis Obliterans / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology