TY - JOUR
T1 - Spinal-cord stimulation for angina pectoris and peripheral vascular disease
AU - Erdek, Michael A.
AU - Staats, Peter S.
PY - 2003/12
Y1 - 2003/12
N2 - SCS is a viable option for treating angina pectoris and inoperable PVD. Its mechanism of action remains controversial, but successful pain relief has been consistently reported in various studies. Many clinicians are foregoing a formal trial, choosing instead to obtain an adequate area of paresthesia and implant in one session. Long-term follow-up of SCS patients treated for angina pectoris shows continued pain relief, increase in activities, and decreased use of medications. Emerging literature supports the finding that SCS is cost-effective in this patient population relative to CABG. SCS does not mask the ischemic pain that signals impending further damage of the myocardium. In patients with inoperable PVD, SCS relieves pain and improves microcirculatory blood flow. Quality of life and mobility can be improved with SCS. The beneficial effects of SCS on ulcer healing are controversial, and evidence suggests that the best candidates for the procedure are those with ischemic rest pain without tissue loss. Patients with diabetes mellitus and hypertension may have the least favorable outcomes with regard to limb salvage. No convincing data have been published on the cost-effectiveness of SCS in this patient population. SCS is a safe procedure that is minimally invasive, reversible, and associated with only infrequent side effects, the most common of which include lead migration and infection. SCS is clearly an option for the improvement of pain and the quality of life in this carefully selected subset of patients.
AB - SCS is a viable option for treating angina pectoris and inoperable PVD. Its mechanism of action remains controversial, but successful pain relief has been consistently reported in various studies. Many clinicians are foregoing a formal trial, choosing instead to obtain an adequate area of paresthesia and implant in one session. Long-term follow-up of SCS patients treated for angina pectoris shows continued pain relief, increase in activities, and decreased use of medications. Emerging literature supports the finding that SCS is cost-effective in this patient population relative to CABG. SCS does not mask the ischemic pain that signals impending further damage of the myocardium. In patients with inoperable PVD, SCS relieves pain and improves microcirculatory blood flow. Quality of life and mobility can be improved with SCS. The beneficial effects of SCS on ulcer healing are controversial, and evidence suggests that the best candidates for the procedure are those with ischemic rest pain without tissue loss. Patients with diabetes mellitus and hypertension may have the least favorable outcomes with regard to limb salvage. No convincing data have been published on the cost-effectiveness of SCS in this patient population. SCS is a safe procedure that is minimally invasive, reversible, and associated with only infrequent side effects, the most common of which include lead migration and infection. SCS is clearly an option for the improvement of pain and the quality of life in this carefully selected subset of patients.
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U2 - 10.1016/S0889-8537(03)00090-7
DO - 10.1016/S0889-8537(03)00090-7
M3 - Review article
C2 - 14719720
AN - SCOPUS:0346102483
SN - 0889-8537
VL - 21
SP - 797
EP - 804
JO - Anesthesiology Clinics of North America
JF - Anesthesiology Clinics of North America
IS - 4
ER -