Spinal cord stimulation in the treatment of non-reconstructable stable critical leg ischaemia: Results of the European Peripheral Vascular Disease Outcome Study (SCS-EPOS)

Abstract

SCS treatment of non-reconstructable critical leg ischaemia provides a significantly better limb survival rate compared with conservative treatment. Patient selection based on TcpO2 and the results of trial screening further increase the probability of limb survival after SCS therapy.

Spinal Cord Stimulation for Chronic Limb Ischemia

“…The study concluded that patient selection based on tcpO 2 trial screening further increases the probability of limb preservation with SCS therapy. 27 In a meta-analysis of 444 patients that compared SCS to any form of conservative treatment for inoperable CLI, patients receiving the device required significantly less analgesia and improved their Fontaine stage classification. The authors observed a stronger trend towards a better rate of amputation-free salvage in the subgroup of patients selected by initial tcpO 2 measurements.…”

Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia

“…Five were national studies: one Belgian 24 , one Swedish 23 , one German 18 and two Dutch 22,37 . One was a recent European multinational CCT 25 . The study size varied from 37 to 120 patients and totalled 444 participating patients.…”

“…In the German study 18 and the European multinational study 25 a period of test stimulation was applied before final implantation of the pulse generator. Control treatment consisted of optimum conservative treatment (local wound care, analgesics, anticoagulants and antibiotics if deemed necessary), which was similar among the studies.…”

“…In the German study 18 , additional prostaglandin therapy was given to both groups. In two trials PtcO 2 measurements were used for patient classification 20,25 .…”

Immersing Feet in Carbon Dioxide-enriched Water Prevents Expansion and Formation of Ischemic Ulcers after Surgical Revascularization in Diabetic Patients with Critical Limb Ischemia

“…18) Amann et al 19) identified the importance of microcirculatory perfusion as the ultimate cause of ischemic tissue loss. Ubbink et al 20) suggested that ischemic ulcers of non-reconstructable CLI might heal without major intervention if local microcirculation is well preserved.…”