Treatment of Unreconstructible Upper Extremity Arterial Occlusive Disease by Spinal Cord Stimulation

Abstract

Spinal cord stimulation (SCS) of peripheral arterial disease (PAD) of the lower limbs has been shown to be effective for pain reduction, limb salvage, and improvement of blood supply; however, treatment of PAD of the upper extremity by SCS has never been performed. Ten patients with unreconstructible severe PAD of the upper extremity were treated by SCS at the authors' institution.

Transcutaneous oxygen tension index (chest TcPo₂/hand TcPo₂), Doppler wrist pressure index (WPI), capillary microscopy (red blood cell velocity, capillary density), and a patient's pain score graded from 1 to 10 (1 =no pain) were used as follow-up parameters.

Pain reduction after SCS was excellent in all patients. TcPo₂ index decreased from 1.95 ± 0.87 prior to implantation to 1.5 ± 1.1 at eighteen months. No significant improvement of capillary microscopy parameters or Doppler WPI could be observed.

SCS effectively reduced pain and provided limb salvage in patients with severe unreconstructible PAD of the upper extremity; however, reduction of pain was not paralleled by improvement of the studied microcirculatory parameters.

Get full access to this article

View all access options for this article.

References

1. Whitehouse WM : Direct revascularization for forearm and hand ischemia. In: Evaluation and Treatment of Upper and Lower Extremity Circulatory Disorders, ed. by Bergan JJ , Yao JST . New York: Grune and Stratton, 1984.

2. Yao JST , McDaniel MD , King TA : Arterial surgery of the upper extremity. In: Clinical Surgery International: Arterial Surgery, ed. by Bergan JJ : London: Churchill Livingstone, 1984, pp 201-224.

3. Jacobs MJHM , Jorning PJG , Beckers RJG , et al: Foot salvage and improvement of microvascular blood flow as a result of epidural spinal cord electrical stimulation. J Vasc Surg 12:354-360, 1990.

4. Jacobs MJHM , Jorning PJG , Joshi SR , et al: Epidural spinal cord electrical stimulation improves microvascular blood flow in severe limb ischemia. Ann Surg 207:179-183, 1988.

5. Tallis RC , Illis LS , Sedgwick EM , et al: Spinal cord stimulation in peripheral vascular disease. J Neurol Neurosurg Psychiatry 46:478-484, 1983.

6. Sciacca V , Mingoli A , Di Marzo L , et al: Predictive value of transcutaneous oxygen tension measure ment in the indication for spinal cord stimulation in patients with peripheral vascular disease: Preliminary results. Vascular Surgery 23:128-132, 1989.

7. Fiume D , Palombi M , Sciacca V , et al: Spinal cord stimulation in peripheral ischemic pain. Pace 12:698-704, 1989.

8. Claeys L , Ktenidis K , Horsch S : Transcutaneous oxygen tension in patients with critical limb ischemia treated by spinal cord stimulation. In: Spinal Cord Stimulation, ed. by Horsch S , Claeys L . Darmstadt: Steinkopff, 1994, pp 145-152.

9. Horsch S , Claeys L : Epidural spinal cord stimulation in the treatment of severe peripheral arterial occlusive disease. Ann Vasc Surg 8:468-474, 1994.

10.

10. Jacobs MJHM , Breslau PJ , Slaaf DW , et al: Nomenclature of Raynaud's phenomenon. A capillary microscopic and hemorheologic study. Surgery 101:136-145, 1987.

11.

11. Tyml K , Ellis CG : Evaluation of the flying spot technique as a television method for measuring red cell velocities in microvessels. Int J Micocirc Clin Exp 1:145-155, 1982.

12.

12. Fagrell B : Techniques and normal findings. In: Clinical Capillaroscopy, ed. by Bollinger A , Fagrell B . Toronto: Hogrefe and Huber, 1990, pp 1-9.

13.

13. Ktenidis K , Claeys L , Horsch S : Epidural spinal cord stimulation (ESCS): Implantation technique. In: Spinal Cord Stimulation, ed. by Horsch S , Claeys L . Darmstadt: Steinkopff, 1994, pp 75-82.

14.

14. Robaina FJ , Dominguez M , Diaz M , et al: Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs. Neurosurgery 24:63-67, 1989.

15.

15. Augustinsson LE , Holm J , Carlsson AC , et al: Epidural Bartels Spinal Cord Stimulation electrical stimulation in severe limb ischemia. Evidence of pain relief, increased blood flow and a possible limb-saving effect. Ann Surg 202:104-111, 1985.