Spinal cord stimulation in peripheral arterial disease. A cooperative study

Area of Science:

• Neurology
• Vascular Surgery
• Pain Management

Background:

• Peripheral arterial disease (PAD) causes significant lower limb pain and impaired mobility.
• Current treatments for PAD, including surgery, are not always suitable or successful.
• Non-invasive therapeutic options are needed for managing PAD symptoms.

Purpose of the Study:

• To evaluate the efficacy of percutaneous epidural stimulation (PES) of the low thoracic spinal cord in patients with lower limb pain due to PAD.
• To assess the impact of PES on pain, claudication distance, peripheral blood flow, and trophic lesions in PAD patients.

Main Methods:

• Forty-one patients with PAD-related lower limb pain underwent a trial of PES.
• Thirty-seven patients proceeded to permanent stimulator implantation after the trial.
• Outcomes were assessed over a mean follow-up of 25 months, evaluating pain, claudication, blood flow (Doppler ultrasound), skin temperature (thermography), and lesion healing.

Main Results:

• Substantial pain relief (75-100%) was achieved in 29 out of 41 patients.
• Claudication distance significantly increased in 15 patients.
• Doppler ultrasound showed improved pulse-wave morphology in 12/23 patients, and thermography indicated increased skin temperature. Small ischemic lesions healed, but gangrene did not improve.

Conclusions:

• Percutaneous epidural stimulation of the spinal cord is an effective alternative treatment for moderate peripheral arterial disorders.
• PES provides significant pain relief and functional improvement in PAD patients unsuitable for or unresponsive to arterial surgery.
• The observed benefits are attributable to the stimulation itself, not placebo or natural disease progression.