The role of spinal cord electric stimulation in critical ischemia of the extremity
Guarnera, G.; Mascellari, L.; Bianchini, G.; Furgiuele, S.; Zucchi, R.; Camilli, S.
Minerva Cardioangiologica 44(12): 663-667
1996
ISSN/ISBN: 0026-4725 PMID: 9053821 Document Number: 455302
The aim of this study is to evaluate, through a retrospective analysis of our experience, the effectiveness of spinal cord stimulation (SCS) in conservative treatment of critical limb ischaemia. During a 7-year period, at our Institution, SCS has been performed in 35 patients affected by severe lower limb ischaemia with angiographic multilevel distal lesions; femoro-distal bypass was not advisable or had failed due to poor outflow conditions. Basing upon clinical criteria (regression of rest pain, claudicatio and ischaemic lesions, limb salvage and need of amputation) the results of therapy were distinguished in "good,", "satisfactory" and "poor". Mean follow-up was 25 months (range 2-80). A good result has been achieved in 17 patients (48.5%) satisfactory in 11 (28.8%) and poor in 7 (20%), with a 80% limb salvage rate. No significative differences were observed in subgroups of patients with diabetes, hypertension or both. Appropriate management of critical limb ischaemia depends on a well-thought-out plan. Although femoro-distal vein bypass has been widely advocated as the treatment of choice, the good result of revascularization is related to adequate outflow conditions (adequate run-off). SCS has been reported to reduce ischaemic pain and improve ulcer healing and microcirculation in ischaemic limbs. Our experience and recent studies have provided strong evidence that SCS reduces tissue loss and improves limb salvage rate in inoperable patients. A prospective randomised study will be helpful in defining if SCS should represent an efficacious and alternative procedure to bypass in the treatment planning of critical leg ischaemia.