Adjuvant spinal cord stimulation improves wound healing of peripheral tissue loss due to steal syndrome of the hand: clinical challenge treating a difficult case

Abstract

Hand ischaemia due to arterial steal syndrome is an infrequent, but potentially serious complication of arteriovenous fistula (AVF) for haemodialysis. We present a case of hand ischaemia caused by steal syndrome in a 69-year-old haemodialysis patient, 10 months after a brachiobasilic fistula creation. The patient underwent multiple operations without resolution of hand pain and tissue loss. The implantation of an adjuvant cervical spinal cord stimulator allowed the patient to obtain complete hand pain relief and wound healing. Probably, the diffuse microangiopathy typical of haemodialysis patients could be responsible for the persistence of ischaemic signs and symptoms after a surgical revascularisation. The effect of sympathetic blockade and the subsequent improvement of the arterial blood flow and tissue oxygenation because of spinal cord stimulation (SCS) can be useful to achieve complete ischaemic pain relief in order to enhance wound healing and to limit the tissue loss. In conclusion, the association of cervical spinal cord stimulation and surgical revascularisation could represent a valid option to treat a critical upper limb ischaemia following steal syndrome due to AVF.

Extreme distal bypass to improve wound healing in Buerger's disease

“…Spinal cord stimulator and vascular endothelial growth factor gene therapy have been used experimentally in patients with TAO with promising results (9)(10)(11)(12).…”

Biomarkers in post‐reperfusion syndrome after acute lower limb ischaemia

“…Acute limb ischaemia (ALI) is a common and often severe clinical event . Its main causes are embolisation, in situ arterial thrombosis, acute graft occlusion or very infrequent complications of arterovenous fistula for haemodialysis .…”

Spinal cord stimulation to achieve wound healing in a primary lower limb critical ischaemia referral centre

“…However, some patients are unfit for revascularisation or a complete resolution of rest pain is not obtained, so they need alternative treatments to improve their quality of life and achieve pain relief and wound healing .…”

“…Spinal cord stimulation (SCS) was introduced by Shealy in 1969 for the treatment of intractable pain and, more recently, SCS indications were extended to patients with gangrene presenting severe comorbidities that render them unsuitable for surgery or in cases of persistent pain or slow and difficult wound healing after successful revascularisation . Complications from SCS include lead migration, lead connection failure, lead break, local pain, wound seroma, haematoma and infection.…”