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[Epidural stimulation in arteritic patients]
1Servicio de Cirugia Cardiovascular, Clinica Universitaria de Navarra, Pamplona, Espagne.
Insights
Epidural stimulation effectively treats lower extremity arterial diseases, improving blood flow and reducing pain in patients with conditions like arteriosclerosis and Buerger
Area of Science:
- Vascular Surgery
- Neuromodulation
- Peripheral Arterial Disease
Background:
- Lower extremity arterial diseases present significant challenges, including intractable pain and tissue necrosis.
- Previous treatments like sympathectomy have variable success rates.
- Epidural stimulation (ES) offers a potential therapeutic option for these complex conditions.
Purpose of the Study:
- To evaluate the efficacy of epidural stimulation in treating patients with severe lower extremity arterial diseases.
- To assess outcomes across various etiologies including arteriosclerosis, diabetic arteriopathy, and specific conditions like Buerger's disease and Raynaud's phenomenon.
Main Methods:
- A multicenter retrospective study involving 203 patients with Leriche-Fontaine stage III or IV ischemia.
- Patients received epidural stimulation for indications such as untractable pain or necrosis.
- Outcomes were assessed based on clinical improvement, plethysmography, transcutaneous PO2, and isotopic perfusion measurements (201TL, 125I antipyrin).
Main Results:
- Excellent outcomes were observed in 47% of arteriosclerosis/diabetes cases, 100% of Buerger's disease cases, and 78% of Raynaud's disease cases.
- Good outcomes were achieved in 33% of arteriosclerosis and 12% of Raynaud's disease cases.
- Statistically significant improvements were noted in plethysmography, transcutaneous PO2, and isotopic perfusion studies.
Conclusions:
- Epidural stimulation demonstrates significant therapeutic potential for managing severe arterial diseases of the lower extremities.
- ES offers a viable treatment option for patients with intractable pain and necrosis unresponsive to conventional therapies.
- The study highlights ES as a promising intervention for improving perfusion and clinical outcomes in peripheral arterial disease.
Abstract:
We are presenting the results of a multicenter retrospective study including 203 patients with arterial disease of the lower extremities, treated with epidural stimulation. The indications were: stage III or IV ischemia of the Leriche-Fontaine classification, arteriosclerosis or diabetic arteriopathy and untractable pain, or presence of necrosis as in Buerger's disease, Raynaud's phenomenon, frost-bite, Sudeck's disease and ergotamin poisoning. 47 p. cent of the patients had undergone a sympathectomy. The evolution was excellent in 47 p. cent of arteriosclerosis and/or diabetes cases, 100 p. cent of cases of Buerger's disease, 78 p. cent of cases of Raynaud's disease, and good in 33 p. cent of patients with arteriosclerosis and 12 p. cent of cases of Raynaud's disease. The plethysmography curves were improved and there was a statistically significant increase of the transcutaneous PO2 as well as of the isotopic results of muscular and cutaneous perfusion with 201TL and 125I antipyrin. These results demonstrate the capabilities of epidural stimulation in the treatment of arterial diseases of the extremities.