TREATMENT OF UNRECONSTRUCTIBLE UPPER EXTREMITY ARTERIAL OCCLUSIVE DISEASE BY SPINAL-CORD STIMULATION

Spinal cord stimulation (SCS) of peripheral arterial disease (PAD) of the lower limbs has been shown to be effective for pain reduction, lim b salvage, and improvement of blood supply; however, treatment of PAD of the upper extremity by SCS has never been performed. Ten patients w ith unreconstructible severe PAD of the upper extremity were treated b y SCS at the authors' institution. Transcutaneous oxygen tension index (chest TcPO2/hand TcPO2), Doppler wrist pressure index (WPI), capilla ry microscopy (red blood cell velocity, capillary density), and a pati ent'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. SGS effectivel y reduced pain and provided limb salvage in patients with severe unrec onstructible PAD of the upper extremity; however, reduction of pain wa s not paralleled by improvement of the studied microcirculatory parame ters.