Epidural Electrical Stimulation in Severe Limb Ischemia

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Abstract
Peripheral vascular disease of the extremities causes ischemic pain and, at times, skin ulcerations and gangrene. In has been suggested that epidural spinal electrical stimulation (ESES) could improve peripheral circulation. Since 1978 ESES was used in 34 patients with severe limb ischemia; all had resting pain and most had ischemic ulcers. Arterial surgery was technically impossible. Twenty-six patients had arteriosclerotic disease, 1 had Buerger''s disease, and 7 had severe vasospastic disorders. Of the patients, 94% experienced pain relief. ESES healed ulcers in 50% of those with preoperative nonhealing skin ulcerations. Seventy percent of the patients showed improved skin temperature recordings. Only 38% of the stimulated arteriosclerotic patients underwent amputations during a mean followup period of 16 mo., as compared to 90% of a comparable group of unstimulated patients. ESES is very promising in severe limb ischemia where reconstructive surgery is impossible or has failed.