title: Spinal cord stimulation in hemodialysis patients with critical lower-limb ischemia.
abstract: BACKGROUND
  Spinal cord stimulation (SCS) has been proposed for the treatment of ischemic pain and the prevention or delay of amputation in patients with peripheral arterial occlusive disease (PAOD) who are unsuitable for vascular reconstruction. PAOD is common in patients with end-stage renal disease and is associated with substantial morbidity and mortality. Furthermore, many patients are not candidates for limb-sparing procedures and have to undergo primary amputation.
  
  
  METHODS
  We report our experience with SCS in 8 hemodialysis patients with chronic lower-limb ischemia and not suitable for either primary surgical or angioplastic intervention or reintervention. Intensity of ischemic pain, quality of life, use of analgesic medications, limb survival, and outcome of skin ischemic lesions were evaluated before implantation of an SCS device and after 6 and 12 months of follow-up.
  
  
  RESULTS
  No complications from SCS device implantation occurred. Both intensity of pain and quality of life significantly improved during follow-up. SCS allowed a decrease in pain medication intake in all patients. Limb survival at 1 year was 75%. Ischemic skin lesions before implantation of an SCS device did not ameliorate during the follow-up period, but the appearance of new lesions was not observed.
  
  
  CONCLUSIONS
  Implantation of an SCS device in patients with end-stage renal disease with critical limb ischemia dramatically improves quality of life and pain relief. In patients assessed at Leriche-Fontaine stage 2 or 3, the treatment might delay the appearance of ischemic skin lesions and amputation. At these stages, presumed long-term benefits could justify the cost of SCS.
authors.affiliation: Blood Purification Unit, Institute of Nephrology, SS Annunziata Hospital, Chieti, Italy.
authors.forename: Uwe
authors.initials: U
authors.lastname: Brümmer
authors.forename: Viviana
authors.initials: V
authors.lastname: Condini
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappelli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Di Liberato
authors.forename: Michele
authors.initials: M
authors.lastname: Scesi
authors.forename: Mario
authors.initials: M
authors.lastname: Bonomini
authors.forename: Amedeo
authors.initials: A
authors.lastname: Costantini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000628:therapy*; D016638:Critical Illness; D004599:Electric Stimulation Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000628:therapy*; D006435:Renal Dialysis; D013116:Spinal Cord