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. 2021 May;55(4):367-373.
doi: 10.1177/1538574420985765. Epub 2021 Feb 8.

Improving Limb Salvage for Chronic Limb-Threatening Ischemia With Spinal Cord Stimulation: A Retrospective Analysis

Anna E Cyrek  1 , Nora Henn  1 , Fabian Meinhardt  1 , Martin Lainka  1 , Arkadius Pacha  2 , Andreas Paul  3 , Dietrich Koch  1
Affiliations

Improving Limb Salvage for Chronic Limb-Threatening Ischemia With Spinal Cord Stimulation: A Retrospective Analysis

Anna E Cyrek et al. Vasc Endovascular Surg. 2021 May.

Abstract

Introduction: Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease (PAD). Up to a third of CLTI patients are not eligible to receive first-line treatments such as bypass surgery or endovascular interventions. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculatory blood flow and relieve ischemic pain in CTLI patients. The aim of the study was to evaluate limb salvage, ulcer closure, and clinical changes of SCS implanted CTLI patients at 1-year follow-up.

Methods: Eligible patients had end-stage lower limb PAD unresponsive to medical therapy and not amenable to surgical reconstruction. Patients were candidates for amputation, but limb loss was not inevitable (Fontaine stage III and IV). Pain intensity and skin temperature in the ischemic area (visual analogue scale), quality of life (WHOQoL-BREF), and ankle/brachial blood pressure index (ABI) were recorded at routine follow-up visits. Data were analyzed retrospectively.

Results: 29 patients underwent SCS implantation at one vascular center. The minimum follow-up period was 30 months. Limb survival at 1-year follow-up was 97% (28/29) and 73% (11/15) had complete closure of limb ulcers. Pain intensity, skin temperature, and quality of life progressively improved up to 12 months after implant, with Fontaine stage III patients improving more substantially than Fontaine stage IV patients. SCS therapy did not affect ABI measurement. No complications related to the device or procedure occurred.

Conclusions: SCS is a valid alternative in patients unsuitable for revascularization. The quality of results depends on both a strict selection of patients by vascular specialists and the frequency of follow-up controls. The therapy may be more beneficial in patients classified as Fontaine stage III.

Keywords: critical ischemia; limb salvage; spinal cord stimulation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Kaplan-Meier estimator. The visit at which the spinal cord stimulator was implanted was counted as time point 0; individuals were subsequently followed until a major end point (major amputation or death) was reached. Panel A and C show the Kaplan-Meier analysis for overall and limb survival, respectively. Panel B and D show the Kaplan-Meier analysis for overall and limb survival according to Fontaine stage, respectively. Full line represents the outcome for Fontaine stage III patients, while the dotted line represents the outcome for Fontaine stage IV patients.
See this image and copyright information in PMC

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