Auricular vagal nerve stimulation in peripheral arterial disease patients

Abstract

Summary:Background: Auricular nerve stimulation has been proven effective in different diseases. We investigated if a conservative therapeutic alternative for claudication in peripheral arterial occlusive disease (PAD) via electroacupuncture of the outer ear can be established. Patients and methods: In this prospective, double-blinded trial an ear acupuncture using an electroacupuncture device was carried out in 40 PAD patients in Fontaine stage IIb. Twenty patients were randomized to the verum group using a fully functional electroacupuncture device, the other 20 patients received a sham device (control group). Per patient, eight cycles (1 cycle = 1 week) of electroacupuncture were performed. The primary endpoint was defi ned as a signifi cantly more frequent doubling of the absolute walking distance after eight cycles in the verum group compared to controls in a standardized treadmill testing. Secondary endpoints were a signifi cant improvement of the total score of the Walking Impairment Questionnaire (WIQ) as well as improvements in health related quality of life using the Short Form 36 Health Survey (SF-36). Results: There were no differences in baseline characteristics between the two groups. The initial walking distance signifi cantly increased in both groups (verum group . SF-36 showed signifi cantly improvements in six out of eight categories in the verum group and only in one of eight in controls. Conclusions: Electroacupuncture of the outer ear seems to be an easy-to-use therapeutic option in an age of increasingly invasive and mechanically complex treatments for PAD patients.

Current Directions in the Auricular Vagus Nerve Stimulation I – A Physiological Perspective

“…aVNS was also reported to increase the velocity of cerebral blood flow in the supratrochlear artery and the middle cerebral artery in single patients (Széles and Litscher, 2004). aVNS decreased the carotid-femoral pulse wave velocity, as shown by a clinical trial in Hackl et al (2017).…”

“…Auricular vagus nerve stimulation significantly improved symptoms in peripheral arterial occlusive disease through significantly increased pain-free walking distance, as shown in a case series in Payrits et al (2011). However, a clinical trial in Hackl et al (2017) has shown a significant increase in the initial walking distance in both verum and control groups, whereas the total scope of the Walking Impairment Questionnaire significantly improved only in the verum group.…”

Non-invasive Auricular Vagus Nerve Stimulation as a Potential Treatment for Covid19-Originated Acute Respiratory Distress Syndrome

“…aVNS therapeutic effects (Kaniusas et al, 2019a , b ) in inflammation, respiratory dysfunction and cardiovascular diseases include reduction of pro-inflammatory cytokines (Tracey, 2007 ; Stavrakis et al, 2015 ), decrease of inflammation level in chronic inflammatory processes like rheumatoid arthritis, postoperative ileus, inflammatory bowel disease (Crohn's disease, ulcerative colitis), systemic inflammation and attenuation of the acute postsurgical inflammatory response after lung lobectomy (Barone et al, 2007 ; Bernateck et al, 2008 ; Chakravarthy et al, 2015 ; Kox et al, 2015 ; Marshall et al, 2015 ; Bonaz et al, 2016 ; Koopman et al, 2016 ; Kwan et al, 2016 ; French et al, 2017 ; Hoover, 2017 ; Salama et al, 2017 ). aVNS resulted in an increase of the middle cerebral and supratrochlear artery blood flow velocity in human subjects (Széles and Litscher, 2004 ) and a decrease of the velocity of the carotid-femoral flow (Hackl et al, 2017 ). aVNS diminishes systolic blood pressure in subjects with coronary artery diseases as well as in subjects with dysfunctions of glucose metabolism (Zamotrinsky et al, 2001 ; Huang et al, 2014 ; Stavrakis et al, 2015 ) it suppresses atrial fibrillation in patients with paroxysmal atrial fibrillation (Afanasiev et al, 2016 ) and reliefs anginal symptoms in coronary artery disease patients (Zamotrinsky et al, 1997 ).…”

Feasibility of pulse rate variability as feedback in closed-loop percutaneous auricular vagus nerve stimulation

“…The ANS ensures homeostasis by regulating the blood circulation (dilation and constriction of blood vessels), the anti-inflammatory response, the function of internal organs and controls the heart rate (HR) and heart rate variability (HRV) [2]. The electrical stimulation of auricular vagal afferents initiates an efferent modulation, resulting in physiological changes that can be used in the treatment of cardiovascular and inflammatory diseases [3][4][5], neurological conditions [6,7] and pain [8]. Compared to surgical procedures and medicamentous treatment, pVNS is a minimally-invasive technique that comes with low risk factors and side-effects and a high overall treatment satisfaction [9].…”