Spinal cord stimulation for unreconstructible chronic limb ischaemia

There is still a lack of prospective randomised studies; at the present we know of only one by Jivegard et al. on a relatively small number of 51 patients. Their results are encouraging, tissue loss being reduced significantly and a trend towards increased limb salvage. The results of ongoing Dutch and American studies are awaited. It has however been shown in convincing microcirculatory studies by Jacobs et al. and others that SCS has a positive effect. Wide clinical experience has also substantiated this; were this not the case it would be hard to understand why elaborate studies by Augustinsson, Meyerson and the prolific work of Linderoth should ever have been designed. Recent communications by Lo Gerfo and others have shown that it is important to visualise the arterial tree all the way down to the foot by selective angiography before pronouncing a leg as non-reconstructible. The 3- and 5-year patency results of femoro- and popliteo-pedal bypass surgery presented by Lo Gerfo are so extraordinary--albeit probably unreproducible by all vascular surgeons--that SCS must be restricted to the truly unoperable or unreconstructable cases of CLI. SCS therefore is definitely not meant to be an alternative to reconstructive techniques!(ABSTRACT TRUNCATED AT 250 WORDS)