La stimulation épidurale dans l'ischémie critique inopérable des membres inférieurs. À propos de 12 cas

Between 2003 and 2011, 12 patients (mean age 60.7 years) with stages III (41.6%) or IV (58.3%) according to the Fontaine classification with non-reconstructible lesions have been supported. Three of them suffered of Buerger disease; all others had multiple vessel revascularizations. Seven needed before epidural cord stimulation implantation a minor amputation. We excluded patients with extensive stage IV and patients not able to understand the principles of the treatment and use of stimulation command. On patient needed a reoperation for device infection. One patient had an electrod breaking following a hip fracture after a fall. Mean follow-up is 45 months, no patient had to undergo amputation of the concerned leg by the implantation of the stimulation. All had recovered a satisfactory level of independence and have arrested the chronic consumption of analgesics. Two of them were able to resume their work without professional reclassification. Surgical selection and follow-up included vascular surgeon, medical algologist, neuro- and/or orthopedic surgeon. Analgesic and vasodilatation induced by epidural spinal cord stimulation is an interesting alternative in critical limb ischemia with non-reconstructible lesions either with classic or endovascular surgery. Few vascular surgeons knew and use this technique, which is an alternative requiring cooperation between several specialties. Morbidity and mortality are low and allow in carefully selected cases to avoid a major amputation, offering the patient to regain its autonomy while reducing its consumption of analgesics.