Laser Doppler Flowmetry and Transcutaneous Oxygen Tension in Patients with Severe Arterial Insufficiency Treated by Epidural Spinal Cord Electrical Stimulation

Abstract

Six patients (3 men, 3 women, mean age 74.2 years) affected by severe arterial insufficiency with rest pain and/or necrosis (smaller than 3 cm2) have been studied simultaneously by means of transcutaneous oxygen tension (Tcp02) and laser Doppler flowmetry (LDF) measurements. They had been submitted to epidural spinal cord electrical stimulation (ESES) device implant from one week to thirteen months previously. Tcp02 vasodilation index and LDF flow and LDF volume increased in 5 patients in whom the ESES was effective in pain relief and ulcer healing. In 1 diabetic patient the clinical result was poor and neither Tcp02 nor LDF showed any improvement. The LDF flow and LDF volume increase, coupled with the simultaneous Tcp02 vasodilation index increase, testify to the amelioration of the cutaneous microcir culation, related to a diminished vasomotor tone (sympathetic activity), induced by ESES . In diabetic patients with neuropathy (autonomic sympathectomy) a high vasodilation index contraindicates ESES implant.