The utilization of transcutaneous oxygen pressures to guide decision-making for spinal cord stimulation implantation for inoperable peripheral vascular disease: a report of two cases.
Spinal cord stimulation (SCS) may be helpful in treating pain and vascular insufficiency associated with inoperable peripheral vascular disease (PVD). Often decision-making regarding progression from trial to implantation is based on subjective measures. Transcutaneous oxygen pressure, a measure of microcirculation and tissue perfusion, provides information on changes that may occur in PVD patients that undergo SCS trials and may provide predictive information for patient outcomes. This article reports on 2 patients with severe PVD in which transcutaneous oxygen pressures were measured during the trial phase, guided progression to implantation, and were followed in the postoperative period. Transcutaneous oxygen pressure values continued to improve following permanent implantation. We provide a review on transcutaneous oxygen pressure monitoring, along with emphasis on the technical aspects of transcutaneous oxygen pressure monitoring and its incorporation into practice. The decision to implant a SCS should be based on not only subjective measures of improvement, but also objective measures of improvement in transcutaneous oxygen pressure. Additional research is warranted to develop transcutaneous oxygen pressure predictive indices to assist in the selection of patients for progression to permanent implantation.
Provenzano
David A
DA
Institute for Pain Diagnostics and Care and Department of Surgery, Ohio Valley General Hospital, McKees Rock, PA 15136, USA. davidprovenzano@hotmail.com
Jarzabek
Gaye
G
Georgevich
Philip
P
D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000294:innervation / Q000503:physiopathology; D001785:Blood Gas Monitoring, Transcutaneous / Q000379:methods*; D002985:Clinical Protocols; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted / Q000592:standards; D005260:Female; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D007866:Leg / Q000098:blood supply / Q000503:physiopathology; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008991:Monitoring, Physiologic / Q000379:methods*; D016491:Peripheral Vascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D011237:Predictive Value of Tests; D012039:Regional Blood Flow / Q000502:physiology*; D012867:Skin / Q000098:blood supply; D013116:Spinal Cord / Q000601:surgery; D013564:Sympathetic Nervous System / Q000503:physiopathology; D016896:Treatment Outcome