[Treatment of chronic critical ischemia of the lower limbs with spinal cord electrostimulation]

The treatment of Fontaine's third and fourth stage chronic critical lower limb ischemia can be considered a medical, social and economic problem. One current form of therapeutic intervention in some cases is medullary electrostimulation (SCS: spinal cord stimulator). This study looks at the period from January 1998 to December 1997 in which patients were selected for an etiological and symptomatological examination. The criteria established at the European Consensus Conference on Critical Leg Ischemia were employed to perform medullary electrostimulation. The entire procedure included a trial period with a temporary implant and if considered tolerable and effective, a permanent implant. One hundred sixty-four patients (117 male and 46 female, aged 41-93) affected by peripheral obstructive arteriopathy were examined. Etiological causes included atherosclerosis (70.7%), diabetes or other atherosclerotic diseases (25%), inflammatory arteriopathy (1.8%) and chronic renal failure under dialysis treatment (2.4%). The procedure was successful in 103 patients (62.8%) while unsuccessful in 61 (37.2%). The best results were obtained in patients at the Fontaine's 3rd stage in which the limb was saved in 72.2% of the patients and at the beginning of the 4th stage with a success rate of 62.7%. The advanced 4th stage had a success rate of only 42.4%. From an etiological point of view, the rate of limb preservation for atherosclerosis patients was 68.1%, in diabetics 56% and inflammatory diseases 33%. However, no positive results were obtained in patients with chronic renal failure.