Epidural spinal cord stimulation following intravenous prostaglandin E1 therapy in non-reconstructible peripheral arterial occlusive disease stage IV

Abstract

Spinal cord stimulation is a medically accepted therapeutic modality for the control of chronic pain (21, 25). For the past two decades, spinal cord stimulation has been advocated as a method of pain relief for therapeutic refractory ischemic pain (8). Strikingly, in vascular patients not only pain relief could be achieved but also healing of ischemic ulcers (2, 7, 10, 11, 12, 13, 24). This suggests that spinal cord stimulation improves the nutritional skin blood flow. This was confirmed in recent studies (15). However, there is a lack of prospective randomized studies, evaluating the effect of spinal cord stimulation on wound healing and limb salvage. Therefore we evaluated the efficacy of spinal cord stimulation on ulcer healing and limb salvage in a randomized-control study in patients with non-reconstructible PAOD undergoing 3 weeks i.v. PG E1. There is enough evidence that prostaglandins are valuable drugs for patients with rest pain and ischemic ulcers. There are no significant differences between the prostacyclin analogue iloprost and PGE1. In several studies it appeared that up to 60 % of patients given iloprost experienced significant pain relief and healing of ischemic ulcers and that during follow-up significantly more patients on iloprost than on placebo were alive without a major amputation (1, 3, 4, 5, 6, 9, 14, 23, 26).