Peripheral Nerve Stimulation in Nonreconstructable Critical Limb-Threatening Ischemia: A Case Series

Area of Science:

• Vascular Surgery
• Pain Management
• Neuromodulation

Background:

• Chronic limb-threatening ischemia (CLTI) often causes severe pain.
• Revascularization is not feasible for all CLTI patients.
• Major amputation is frequently the only treatment option for refractory pain in CLTI.

Purpose of the Study:

• To evaluate the efficacy of ultrasound-guided peripheral nerve stimulation (PNS) for pain relief.
• To assess the potential of PNS for limb preservation in nonreconstructable CLTI patients.

Main Methods:

• Ten patients with severe peripheral arterial disease and nonreconstructable CLTI were included.
• Ultrasound-guided PNS of the femoral and sciatic nerves was performed for analgesia.
• Outcomes regarding pain management and need for amputation were recorded.

Main Results:

• Two patients successfully avoided major amputation.
• Eight patients underwent amputation a median of 33 days post-PNS implantation.
• PNS provided pain relief and temporary limb preservation in some cases.

Conclusions:

• Peripheral nerve stimulation (PNS) may offer a viable option for pain management in CLTI patients.
• PNS can potentially delay the need for major amputation in select CLTI cases.
• Further research is warranted to confirm the role of PNS in limb salvage for CLTI.