586 Case Series: Neurostimulation - a Promising Option for Treatment of Chronic Peripheral Arterial Disease When Revascularization and Conservative Management Are Unsuitable

Abstract

Abstract Parasympathetic stimulation has been implicated in improving circulation in the extremities by causing arteriolar dilatation, which could plausibly be useful in patients with peripheral arterial disease (PAD). Herein, we illustrate 5 cases (4 males and 1 female, age 40–75) of chronic disabling intermittent limb claudication without any ischaemic rest pain who were offered Neurostimulation since conservative treatment did not help and no other revascularization options were deemed suitable. Each of these patients had a pre-neurostimulation arterial duplex scan to depict the extent of occlusion; measure diameter of vessels and their blood flow, ABPI and absolute ankle pressure. Pain score, claudication distance and impact on quality-of-life pre-stimulation were recorded in the patient clinic notes. Non-invasive Ducest Neurostimulator was implanted in the auricular fossa triangularis for two sessions of 3 weeks treatment. Post-neurostimulation arterial duplex scan was repeated to compare any changes in the vessel diameter, blood flow and ABPI. Significant improvement in the symptoms of PAD was noted in all the cases. Post-treatment, the patients felt much more comfortable- their pain score reduced significantly (to 0 in 2 of the cases); and 2 to 16-fold increase in their walking distance as compared to pre-treatment. Remarkable symptomatic relief was in line with profound (2–8 times) improvement in blood flow which was quantified using vessel diameter, tibial flow volume, and hand-held doppler signal. ABPI and absolute pressure either remained near unchanged or increased post treatment. This series strongly suggests a beneficial role of neurostimulation in the symptomatic treatment of PAD in selective cases.