Brümmer Uwe, Condini Viviana, Cappelli Paolo, Di Liberato Lorenzo, Scesi Michele, Bonomini Mario, Costantini Amedeo
Blood Purification Unit, Institute of Nephrology, SS Annunziata Hospital, Chieti, Italy.
Am J Kidney Dis. 2006 May;47(5):842-7. doi: 10.1053/j.ajkd.2006.02.172.
Spinal cord stimulation (SCS) has been proposed for the treatment of ischemic pain and the prevention or delay of amputation in patients with peripheral arterial occlusive disease (PAOD) who are unsuitable for vascular reconstruction. PAOD is common in patients with end-stage renal disease and is associated with substantial morbidity and mortality. Furthermore, many patients are not candidates for limb-sparing procedures and have to undergo primary amputation.
We report our experience with SCS in 8 hemodialysis patients with chronic lower-limb ischemia and not suitable for either primary surgical or angioplastic intervention or reintervention. Intensity of ischemic pain, quality of life, use of analgesic medications, limb survival, and outcome of skin ischemic lesions were evaluated before implantation of an SCS device and after 6 and 12 months of follow-up.
No complications from SCS device implantation occurred. Both intensity of pain and quality of life significantly improved during follow-up. SCS allowed a decrease in pain medication intake in all patients. Limb survival at 1 year was 75%. Ischemic skin lesions before implantation of an SCS device did not ameliorate during the follow-up period, but the appearance of new lesions was not observed.
Implantation of an SCS device in patients with end-stage renal disease with critical limb ischemia dramatically improves quality of life and pain relief. In patients assessed at Leriche-Fontaine stage 2 or 3, the treatment might delay the appearance of ischemic skin lesions and amputation. At these stages, presumed long-term benefits could justify the cost of SCS.
脊髓刺激（SCS）已被提议用于治疗缺血性疼痛，并预防或延缓不适于血管重建的外周动脉闭塞性疾病（PAOD）患者的截肢。PAOD在终末期肾病患者中很常见，且与高发病率和死亡率相关。此外，许多患者不适合保肢手术，不得不接受初次截肢。
我们报告了8例慢性下肢缺血且不适合初次手术、血管成形干预或再次干预的血液透析患者接受SCS的经验。在植入SCS设备前以及随访6个月和12个月后，评估缺血性疼痛强度、生活质量、镇痛药物使用情况、肢体存活情况以及皮肤缺血性病变的结果。
SCS设备植入未发生并发症。随访期间疼痛强度和生活质量均显著改善。SCS使所有患者的止痛药物摄入量减少。1年时肢体存活率为75%。植入SCS设备前的缺血性皮肤病变在随访期间未改善，但未观察到新病变出现。
在患有严重肢体缺血的终末期肾病患者中植入SCS设备可显著改善生活质量并缓解疼痛。在Leriche-Fontaine 2期或3期评估的患者中，该治疗可能会延迟缺血性皮肤病变和截肢的出现。在这些阶段，假定的长期益处可能证明SCS的成本是合理的。
