Cyrek Anna E, Koch Dietrich, Pacha Arkadius, Radunz Sonia
Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Institute of Pharmacology and Toxicology, Ruhr-University Bochum, Bochum, Germany.
Front Surg. 2024 Dec 9;11:1451622. doi: 10.3389/fsurg.2024.1451622. eCollection 2024.
Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease (PAD). Patients with diabetes mellitus (DM) have a faster progression of PAD and a fourfold increased risk of CLTI compared to patients without DM. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculation, relieve ischemic pain and reduce the number of amputations in patients with PAD. This is a retrospective small cohort analysis of patients with diabetes and the long-term treatment effect of spinal cord stimulation.
As the main outcome of the study, we evaluated the survival and amputation of 13 diabetic patients with chronic lower-limb ischemia who were not eligible for surgical or interventional therapy. Secondary outcomes included ankle-brachial index (ABI), ischemic pain intensity, quality of life, use of analgesic medications and skin wound outcomes analyzed during long-term follow-up.
Between January 2010 and January 2017, 13 patients underwent SCS implantation in our vascular center. At 1-year follow-up, the limb salvage rate was 92.3% (12 of 13 patients), and limb ulcers healed in 75% of patients (6/8). No patient died during the one-year follow-up. A total of 4 of patients (31%) experienced major amputation during long-term follow-up, all of them were Fontaine stage IV. Pain intensity and quality of life improved significantly at 6-month follow-up ( < 0.05). ABI measurements were unaffected by SCS treatment. There were no complications related to the procedure or device.
SCS is a promising treatment option for diabetic patients unsuitable for endovascular or surgical revascularization. The method improves limb survival in diabetic patients with critical limb ischemia, provides significant pain control, and improves patients' quality of life. However, more studies are needed to clarify the indications for SCS and clarify its effects on the vascular system.
慢性肢体威胁性缺血（CLTI）是外周动脉疾病（PAD）最严重的形式。与非糖尿病患者相比，糖尿病（DM）患者的PAD进展更快，发生CLTI的风险增加四倍。硬膜外脊髓刺激（SCS）已被用作改善PAD患者微循环、缓解缺血性疼痛和减少截肢次数的一种方法。这是一项对糖尿病患者进行脊髓刺激长期治疗效果的回顾性小队列分析。
作为研究的主要结果，我们评估了13例不适合手术或介入治疗的慢性下肢缺血糖尿病患者的生存情况和截肢情况。次要结果包括在长期随访期间分析的踝臂指数（ABI）、缺血性疼痛强度、生活质量、镇痛药使用情况和皮肤伤口结果。
2010年1月至2017年1月期间，13例患者在我们的血管中心接受了SCS植入。在1年的随访中，肢体挽救率为92.3%（13例患者中的12例），75%的患者（6/8）肢体溃疡愈合。在1年的随访中无患者死亡。共有4例患者（31%）在长期随访期间接受了大截肢，他们均为Fontaine IV期。在6个月的随访中，疼痛强度和生活质量显著改善（<0.05）。ABI测量不受SCS治疗的影响。没有与手术或设备相关的并发症。
SCS是不适用于血管内或手术血运重建的糖尿病患者的一种有前景的治疗选择。该方法可提高患有严重肢体缺血的糖尿病患者的肢体存活率，有效控制疼痛，并改善患者的生活质量。然而，需要更多的研究来明确SCS的适应症并阐明其对血管系统的影响。
