Spinal Cord Stimulation for Non-Reconstructable Chronic Limb-Threatening Ischemia: A Real-World, Multidisciplinary,...

Area of Science:

• Vascular Surgery
• Neuromodulation
• Peripheral Artery Disease Management

Background:

• Chronic limb-threatening ischemia (CLTI) is a severe peripheral artery disease stage.
• CLTI presents with ischemic rest pain or ulcer necrosis, significantly impacting quality of life.
• Spinal cord stimulation (SCS) is a European treatment option for CLTI patients experiencing chronic pain.

Purpose of the Study:

• To evaluate the long-term, real-world effectiveness of SCS therapy in CLTI patients.
• To assess improvements in pain, mobility, and limb preservation following SCS treatment.
• To identify factors associated with amputation risk after SCS intervention.

Main Methods:

• Observational study utilizing medical chart review.
• Analysis of consecutive CLTI patients who underwent SCS implantation between 2013 and 2022.
• Assessment of outcomes including pain scores, walking distance, skin lesion status, and limb survival rates.

Main Results:

• Significant reduction in pain intensity (NRS 9.4 to 3.7) and increase in walking distance (>350m) at 2 years post-SCS.
• Stabilization of skin lesions in 63% of patients.
• 12-month limb survival rates of 90% (Fontaine IIb/III) and 70% (Fontaine IV); amputation risk associated with Fontaine Stage, smoking, hypertension, and prior amputation.
• No major complications reported.

Conclusions:

• SCS therapy offers significant and durable improvements in ischemic pain and functional outcomes for CLTI patients.
• SCS may reduce the risk of major amputation in CLTI, especially when initiated in earlier disease stages.
• Real-world data support SCS as a valuable treatment modality for managing CLTI.