Improvement of microcirculatory blood flow under epidural spinal cord stimulation in patients with nonreconstructible peripheral arterial occlusive disease

Epidural spinal cord stimulation (ESCS) has been suggested as a method to improve microcirculatory blood flow and to reduce the amputation rate in vascular patients. We studied the effects of ESCS on microcirculatory blood flow in 237 patients with nonreconstructible peripheral arterial occlusive disease. Clinical status was classified as Fontaine Stage 3 (ischemic rest pain) in 169 patients and as Fontaine Stage 4 (ulcers/gangrene) in 68 patients. After a mean follow-up period of 31.2 months, major pain relief (>75%) was noticed in patients who retained their limbs. Sixty-four patients underwent major amputation despite ESCS. Clinical improvement was confirmed by the increase in transcutaneous oxygen (TcPo2).