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Improving Limb Salvage for Chronic Limb-Threatening Ischemia With Spinal Cord Stimulation: A Retrospective Analysis
Anna E Cyrek1, Nora Henn1, Fabian Meinhardt1
1Division of Vascular and Endovascular Surgery, Department of General, Visceral and Transplantation Surgery, 39081University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Insights
Spinal cord stimulation (SCS) offers a viable treatment for chronic limb-threatening ischemia (CLTI) in patients ineligible for surgery. This therapy improves limb salvage, ulcer healing, and pain relief, particularly in Fontaine stage III patients.
Area of Science:
- Vascular Surgery
- Neuromodulation
- Regenerative Medicine
Background:
- Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease (PAD).
- A significant portion of CLTI patients are unsuitable for conventional revascularization procedures.
- Spinal cord stimulation (SCS) is explored to enhance microcirculation and alleviate ischemic pain in CLTI.
Purpose of the Study:
- To assess the efficacy of SCS in CLTI patients ineligible for standard treatments.
- Evaluate limb salvage rates, ulcer healing, and overall clinical improvements at 1-year follow-up.
Main Methods:
- Retrospective analysis of 29 CLTI patients (Fontaine stage III-IV) receiving SCS.
- Exclusion criteria included suitability for bypass surgery or endovascular intervention.
- Outcomes measured: limb survival, ulcer closure, pain intensity (VAS), quality of life (WHOQoL-BREF), and ankle-brachial index (ABI).
Main Results:
- 97% limb survival at 1-year (28/29 patients).
- 73% complete ulcer closure (11/15 patients).
- Significant improvements in pain, skin temperature, and quality of life up to 12 months post-SCS; Fontaine stage III showed greater improvement than stage IV. No impact on ABI. No device-related complications.
Conclusions:
- SCS presents a valuable alternative for CLTI patients not amenable to revascularization.
- Patient selection and follow-up frequency are critical for optimal outcomes.
- Fontaine stage III patients may experience more substantial benefits from SCS therapy.
Introduction:
Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease (PAD). Up to a third of CLTI patients are not eligible to receive first-line treatments such as bypass surgery or endovascular interventions. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculatory blood flow and relieve ischemic pain in CTLI patients. The aim of the study was to evaluate limb salvage, ulcer closure, and clinical changes of SCS implanted CTLI patients at 1-year follow-up.
Methods:
Eligible patients had end-stage lower limb PAD unresponsive to medical therapy and not amenable to surgical reconstruction. Patients were candidates for amputation, but limb loss was not inevitable (Fontaine stage III and IV). Pain intensity and skin temperature in the ischemic area (visual analogue scale), quality of life (WHOQoL-BREF), and ankle/brachial blood pressure index (ABI) were recorded at routine follow-up visits. Data were analyzed retrospectively.
Results:
29 patients underwent SCS implantation at one vascular center. The minimum follow-up period was 30 months. Limb survival at 1-year follow-up was 97% (28/29) and 73% (11/15) had complete closure of limb ulcers. Pain intensity, skin temperature, and quality of life progressively improved up to 12 months after implant, with Fontaine stage III patients improving more substantially than Fontaine stage IV patients. SCS therapy did not affect ABI measurement. No complications related to the device or procedure occurred.
Conclusions:
SCS is a valid alternative in patients unsuitable for revascularization. The quality of results depends on both a strict selection of patients by vascular specialists and the frequency of follow-up controls. The therapy may be more beneficial in patients classified as Fontaine stage III.
