Predictors of Improved Quality of Life and Claudication in Patients Undergoing Spinal Cord Stimulation for Critical Lower Limb Ischemia

Tshomba, Yamume; Psacharopulo, Daniele; Frezza, Serena; Marone, Enrico Maria; Astore, D.; Chiesa, Roberto

doi:10.1016/j.avsg.2013.06.020

Cited by 18 publications

(17 citation statements)

References 15 publications

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“…В результате этого пациенты могут в большей степени сохранять двигательную активность, что способствует улучшению коллатеральных путей кровоснабжения [36].…”

Section: механизм действия и прямые эффекты спинальной нейростимуляцииunclassified

“…В этой группе применение спинальной нейростимуляции при нереконструируемой КИНК обеспечивало более высокие показатели сохранности конечности по срав-нению с консервативной терапией. Tshomba Y. и со-авторы [36], проанализировав долгосрочные исходы у 274 пациентов, которым выполнялась спинномозговая стимуляция, показали, что значимым предиктором ус-пеха (определявшегося как способность пройти не менее 30 м без появления боли) является относитель-но раннее начало SCS -2-5 мес. после появления язв на нижних конечностях, тогда как, за исключением единичных случаев, при начале SCS через 12-15 мес.…”

Section: отбор пациентов для имплантации системы спинальной нейростимunclassified

“…2017;21(2):29-42 DOI: 10.21688-1681-3472-2017-2- [29][30][31][32][33][34][35][36][37][38][39][40][41][42] сравнении с консервативной терапией. Единственным исключением среди рандомизированных исследова-ний является работа H.M. Klomp и соавторов [62], ко-торые не получили значимых различий между группами SCS и консервативной терапии.…”

Section: Reviewsunclassified

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Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Ashurkov¹,

Levin²,

Murtazin³

et al. 2017

PKiK

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Critical limb ischemia (CLI) is a state of substantial reduction of blood flow in the extremities, mostly due to severe obstruction of the arteries. In lower limbs, it produces severe pain after even a short distance walk (intermittent claudication) and/or skin ulcers or sores. Surgical revascularization is a “golden standard” in CLI therapy, but it is contraindicated or not accessible for a large proportion of patients, while the medical prognosis is poor for conservative therapy. This situation stimulated the development of alternative approaches, including spinal cord stimulation (SCS) and various methods of “indirect” revascularization. In this paper, the authors give a short description of the latest approaches and a detailed review of the SCS method, while paying special attention to the studies that demonstrate not only a palliative effect of SCS (pain reduction), but also clinically significant changes in the indicators of lower limb muscles blood supply. CLI is characterized with a "vicious circle": pain causes reduced mobility and changes in the preferred limb position, which in turn lead to edema triggering an increase of ischemia and further elevation of pain. The clinical effects of SCS in CLI patients are related both with pain relief leading to a break of this vicious circle, and with the direct vasodilatory effects of the stimulation itself. There are several possible biological mechanisms of these actions, but most probably the therapeutic actions of SCS arise from their combination. Examination of different opinions about the appropriateness of spinal cord stimulation in patients with CLI, including those related to the economic efficiency of the method, leads to the conclusion that the evidence on these issues is currently insufficient. The reviewed data demonstrate the need for further development of the CLI treatment methods and high urgency of this problem.Received 6 April 2017. Accepted 23 April 2017.Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest.

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Section: механизм действия и прямые эффекты спинальной нейростимуляцииunclassified

Section: отбор пациентов для имплантации системы спинальной нейростимunclassified

Section: Reviewsunclassified

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Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Ashurkov¹,

Levin²,

Murtazin³

et al. 2017

PKiK

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“…Conservative medical treatment, which consists of analgesics, vasodilators, and anticoagulants, is the only option and is necessary in the management of NR‐CLI patients that are unsuitable for revascularization. In addition, spinal cord stimulation (SCS) has become an alternative and potential clinical practice for the treatment of intractable pain of the heart or extremities via pain reduction as well as to improve the microcirculatory blood flow . The analgesic mechanism is attributed to the gate‐control theory and the modulation of neurotransmitter release in the dorsal horn .…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Stimulation Improves the Microvascular Perfusion Insufficiency Caused by Critical Limb Ischemia

Liu

Chen

et al. 2018

Neuromodulation: Technology at the Neural Interface

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“…4 Spinal cord stimulation (SCS) is another surgical intervention that was shown to effectively diminish claudication and improve quality of life measures in patients with critical limb ischemia. 12 However, clear indication to implant SCS is limited to patients with severe ischemia where other surgical interventions are not warranted or have failed. 13 …”

Section: Introductionmentioning

confidence: 99%

Functional electrical stimulation improves quality of life by reducing intermittent claudication

Embrey

Alon

Brandsma

et al. 2017

International Journal of Cardiology

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Objective To determine if Functional Electrical Stimulation (FES) would improve ischemic pain, walking distance, and quality of life of patients with intermittent claudication. Design Single blind, randomized block, two factorial design. Patients Patients diagnosed with Peripheral Artery Disease (PAD) and intermittent claudication (IC). Ankle Brachial Index ranged 0.4–0.9 on at least one leg. Patients were randomly assigned to experimental (FES+Walk, N=13) or control (WALK, N=14) groups. Intervention Experimental group patients received FES to the dorsiflexor and plantarflexor muscles while walking for one hour/day, six days/week for eight weeks. Control group patients received similar intervention without FES. A Follow-up period of both groups lasted eight weeks. Outcome Measures Outcome measures were taken at baseline (T0), after intervention (T1), and after follow-up (T2). Primary measures included Perceived Pain Intensity (PPI), Six Minute Walk (6MW), and Peripheral Arterial Disease Quality of Life (PADQOL). Secondary measures included Intermittent Claudication Questionnaire (ICQ) and Timed Up and Go (TUG). Results Group by time interactions in PPI were significant (P<.001) with differences of 27.9 points at T1 and 36.9 points at T2 favoring the FES+Walk group. Groups difference in Symptoms and Limitations in Physical Function of the PADQOL reached significance (T1=8.9, and T2=8.3 improvements; P=.007). ICQ was significant (T1=9.3 and T2=13.1 improvements; P=.003). Improvement in 6MW and TUG tests were similar between groups. Conclusions and Relevance Walking with FES markedly reduced ischemic pain and enhanced QOL compared to just walking. FES while walking may offer an effective treatment option for the elderly with PAD and Intermittent Claudication.

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Predictors of Improved Quality of Life and Claudication in Patients Undergoing Spinal Cord Stimulation for Critical Lower Limb Ischemia

Cited by 18 publications

References 15 publications

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Spinal Cord Stimulation Improves the Microvascular Perfusion Insufficiency Caused by Critical Limb Ischemia

Functional electrical stimulation improves quality of life by reducing intermittent claudication

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