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

Abstract

Critical lower limb ischaemia is a diffuse pathology that could cause claudication, severe ischaemic pain and tissue loss. The common treatment includes modification of risk factors, pharmacological therapy and endovascular or surgical revascularisation of the lower limb to restore a pulsatile flow distally. Spinal cord stimulator is seen as a valid alternative in patients unsuitable for revascularisation after endovascular or surgical revascularisation failure and as adjuvant therapy in the presence of a functioning bypass in patients with extensive tissue loss and gangrene presenting a slow and difficult wound healing. We report our experience on spinal cord stimulation (SCS) indication and implantation in patients with critical lower limb ischaemia, at a high-volume centre for the treatment of peripheral arterial disease.

Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis

“…Physicians might be more cautious in the use of methods that require contrast medium, such as angiography or endovascular procedures, being concerned of worsened kidney function on the basis of an often concomitant chronic kidney disease. However, recent data substantiate this concern unfounded [27] and rated secondary in the face of a high risk for limb loss and death, particularly associated with non-healed wounds [6, 17, 19, 28]. …”

Endo First Is Not Appropriate in Some Patients with Critical Limb Ischemia because “Bridges Are Burned”

“…Most frequently, the patients were claudicants at the time of first treatment with a discrete collateral circle and with limited ulcerations or gangrene, so also in case of a failure, an adequate and intensive medical therapy associated in some particular case with spinal cord stimulation aided patients to conserve the limb as we recently published. 17 Our data suggest that EV should not be attempted as the first-line treatment in every patient affected with CLI because when the EV fails or does not provide sufficient clinical benefit, the results of a subsequent distal bypass should be significantly worse in some cases than in previously untreated patients.…”

Spinal Cord Stimulation for Acute Pain Following Surgery for Cervical Myelopathy: A Novel Treatment Strategy

“…This technique of SCS is normally restricted to patients suffering from chronic neuropathic or vascular pain syndromes. In the setting of ischemic pain secondary to peripheral vascular disease and critical limb ischemia, and in the treatment of acute vasculitis, SCS has emerged as a beneficial therapy that relieves ischemic pain and improves microcirculatory perfusion and the likelihood of limb survival . However, despite over 50 years of clinical utilization and research, our understanding of the mechanisms by which SCS diminishes pain is limited .…”

“…In the setting of ischemic pain secondary to peripheral vascular disease and critical limb ischemia, and in the treatment of acute vasculitis, SCS has emerged as a beneficial therapy that relieves ischemic pain and improves microcirculatory perfusion and the likelihood of limb survival. [38][39][40][41] However, despite over 50 years of clinical utilization and research, our understanding of the mechanisms by which SCS diminishes pain is limited. 42 Nevertheless, in animal models of neuropathic pain, SCS has been shown to inhibit the hyperexcitability of dorsal horn wide dynamic range neurons and induce the release of GABA in the dorsal horns of the spinal cord gray matter, which results in subsequent amelioration of glutamatergic neurotransmission.…”