Spinal cord stimulation for patients with inoperable chronic critical leg ischemia

The Clinical Outcomes in Patients with Critical Limb Ischemia One Year after Spinal Cord Stimulation

“…5 However, the irreversible morphofunctional changes in the microcirculatory system in patients with CLI may not bring about the desired result after SCS. 23 Thus, according to our findings, a combination of low tissue metabolism values (restTcPO 2 <10 mm Hg) and an abrupt disruption of the adaptive mechanisms of the microvasculature presenting as a lack of increase in the level of transcutaneous oxygenation during the orthostatic test negatively affected the clinical dynamics after SCS. Accordingly, the adaptive increase in the standTcPO 2 value by more than 10 mm Hg was associated with the positive clinical dynamics after SCS.…”

The Effects of Spinal Cord Stimulators on End Organ Perfusion: A Literature Review

“…The FDA is currently looking into end-stage PVD and refractory angina as there is strong literature support flowing in from countries abroad. Nonetheless, some insurance companies within the United States have already begun to cover SCS for these disease processes as off-label treatments [1].…”

“…The electrode is connected to an internal pulse generator which is either of the non-rechargeable or rechargeable type and is programmed by an external transcutaneous telemetry device. Patients have the liberty to turn on/off the device and control the stimulation amplitude and frequency to better aid in pain relief [1][2].…”

“…This in turn depolarizes nerve terminals and releases vasoactive substances like calcitonin gene-related peptide (CGRP) which are known to have potent microvascular vasodilatory properties. CGRP causes endothelial cells to release Nitric oxide (NO) and stimulates blood vessel smooth muscle relaxation, thus causing a decrease in vascular resistance [1][2][3].…”

“…The idea behind this is that SCS decreases efferent sympathetic activity, thus decreasing alpha-1 activity in the vasculature and causing the release of vasoconstriction. The literature currently sites both working in concert to ultimately cause an increase in lower extremity blood flow, while at the same time suppressing nociceptor signals to the brain, all resulting in better pain and symptom control [1][2][3]. Since then, many studies have demonstrated a benefit of using SCS for patients who suffer from chronic limb ischemia.…”