Spinal Cord Stimulation for Chronic Limb Ischemia

Naoum, Joseph J.; Arbid, Elias J.

doi:10.14797/mdcj-9-2-99

Cited by 35 publications

(12 citation statements)

References 30 publications

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“…In SCS, electrodes are implanted in the lumbar epidural space and connected to a generator to stimulate sensory fibers. 462 SCS promotes activation of cell signaling pathways that cause the release of vasodilatory molecules, leading to a decrease in vascular resistance and relaxation of smooth muscle cells. 462 This improved peripheral microcirculatory status has been shown to result in increased capillary flow and density of perfusing capillaries, higher skin temperature and local TcPO 2 , normalization of pulse wave morphology, and improved skin nutrition.…”

Section: Interventional Nonrevascularization Treatmentsmentioning

confidence: 99%

Global vascular guidelines on the management of chronic limb-threatening ischemia

Conte

Bradbury

Kolh³

et al. 2019

Journal of Vascular Surgery

1,127

865

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Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.

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Section: Interventional Nonrevascularization Treatmentsmentioning

confidence: 99%

Global vascular guidelines on the management of chronic limb-threatening ischemia

Conte

Bradbury

Kolh³

et al. 2019

Journal of Vascular Surgery

1,127

865

View full text Add to dashboard Cite

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“…A small prospective open-label study in PDPN patients failed to demonstrate a significant effect of CON-SCS on microcirculatory function, whereas these patients did experience pain relief (de Vos et al, 2009). On the other hand, several studies do suggest a correlation between increased blood perfusion and alleviation of clinical symptoms in conditions with peripheral artery disease Sciacca, 1999, 2000b;Ubbink et al, 1999;Naoum and Arbid, 2013). As HF-SCS has been demonstrated to result in increased vasodilatory responses compared with CON-SCS, HF-SCS in particular could improve SCS outcome in chronic PDPN (Gao et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Spinal cord stimulation in experimental chronic painful diabetic polyneuropathy: Delayed effect of High‐frequency stimulation

Beek

Kleef²,

Linderoth

et al. 2016

European Journal of Pain

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BackgroundSpinal cord stimulation (SCS) has been shown to provide pain relief in painful diabetic polyneuropathy (PDPN). As the vasculature system plays a great role in the pathophysiology of PDPN, a potential beneficial side‐effect of SCS is peripheral vasodilation, with high frequency (HF) SCS in particular. We hypothesize that HF‐SCS (500 Hz), compared with conventional (CON) or low frequency (LF)‐SCS will result in increased alleviation of mechanical hypersensitivity in chronic experimental PDPN.MethodsDiabetes was induced in 8‐week‐old female Sprague–Dawley rats with an intraperitoneal injection of 65 mg/kg of streptozotocin (n = 44). Rats with a significant decrease in mechanical withdrawal response to von Frey filaments over a period of 20 weeks were implanted with SCS electrodes (n = 18). Rats were assigned to a cross‐over design with a random order of LF‐, CON‐, HF‐ and sham SCS and mechanical withdrawal thresholds were assessed with von Frey testing.ResultsCompared with sham treatment, the average 50% WT score for 5 Hz was 4.88 g higher during stimulation (p = 0.156), and 1.77 g higher post‐stimulation (p = 0.008). CON‐SCS resulted in 50% WT scores 5.7 g, and 2.51 g higher during (p = 0.064) and after stimulation (p < 0.004), respectively. HF‐SCS started out with an average difference in 50% WT score compared with sham of 1.87 g during stimulation (p = 0.279), and subsequently the steepest rise to a difference of 5.47 g post‐stimulation (p < 0.001).ConclusionsWe demonstrated a delayed effect of HF‐SCS on mechanical hypersensitivity in chronic PDPN animals compared with LF‐, or CON‐SCS.SignificanceThis study evaluates the effect of SCS frequency (5–500 Hz) on mechanical hypersensitivity in the chronic phase of experimental PDPN. High frequency (500 Hz) – SCS resulted in a delayed effect‐ on pain‐related behavioural outcome in chronic PDPN.

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“…The mechanism of action of PNS in the suppression of sympathetic vasoconstriction may be similar to the mechanism of antisympathetic activity of SCS linked to the release of vasodilators after stimulation of fibers in dorsal root ganglia. 26 …”

Section: Discussionmentioning

confidence: 99%

Tibial nerve stimulation with a miniature, wireless stimulator in chronic peripheral neuropathic pain

Sokal¹,

Harat²,

Zieliński³

et al. 2017

JPR

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Peripheral neuropathic pain (PNP) and complex regional pain syndrome (CRPS) can be effectively treated with peripheral nerve stimulation. In this clinical trial report, effectiveness of novel, miniature, wirelessly controlled microstimulator of tibial nerve in PNP and CRPS was evaluated. In this pilot study the average preoperative visual analog scale (VAS) score in six patients was 7.5, with 1, 3 and 6 months: 2.6 (p=0.03), 1.6 (p=0.03), and 1.3 (p=0.02), respectively. The mean average score in the six patients a week preceding the baseline visit was 7.96, preceding the 1, 3 and 6 month visits: 3.32 (p=0.043), 3.65 (p=0.045), and 2.49 (p=0.002), respectively. The average short-form McGill pain score before surgery was 23.8, and after 1, 3 and 6 months it was 11.0 (p=0.45), 6.3 (p=0.043), and 4.5 (p=0.01), respectively. Applied therapy caused a reduction of pain immediately after its application and clinical improvement was sustained on a similar level in all patients for six months. No complications of the treatment were observed. Intermittent tibial nerve stimulation by using a novel, miniature, wirelessly controlled device can be effective and feasible in PNP and CRPS. It is a safe, minimally invasive, and convenient neuromodulative method.

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Spinal Cord Stimulation for Chronic Limb Ischemia

Cited by 35 publications

References 30 publications

Global vascular guidelines on the management of chronic limb-threatening ischemia

Global vascular guidelines on the management of chronic limb-threatening ischemia

Spinal cord stimulation in experimental chronic painful diabetic polyneuropathy: Delayed effect of High‐frequency stimulation

Tibial nerve stimulation with a miniature, wireless stimulator in chronic peripheral neuropathic pain

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