EPV019 - CURRENT STATE OF SPINAL CORD STIMULATION FOR PERIPHERAL VASCULAR DISEASE (ID 429)
- Philipp J. Slotty, Germany
- Philipp J. Slotty, Germany
- Jan Vesper, Germany
- Sebastian Gillner, Germany
- Guilherme Santos Piedade, Germany
Abstract
Introduction
Although under investigation for several decades, spinal cord stimulation is not established in the treatment of peripheral vascular disease. The global vascular guidelines from 2019 found good scientific data on the efficacy of SCS on numerous aspects of PVD but conclude in a grade 2 (weak) recommendation based on a level 2 (moderate) level of evidence. One of the main points of criticism are the high treatment costs per case compared to other options and high complication rates.
Methods/Materials
We analyzed the publications and their interpretation leading to the current state of spinal cord stimulation in the treatment of peripheral vascular disease. Additionally, we looked at the neuromodulation society and experts reaction by means of new studies and concepts to increase the use of spinal cord stimulation in peripheral vascular disease.
Results
The available good quality studies on spinal cord stimulation for PVD all had limb salvage as a primary endpoint. The number needed to treat to save one limb was calculated as 13 with treatment costs for one saved limb exceeding $110.000.
Smaller studies focused on the mechanism of action and found numerous well-investigated positive effects of spinal cord stimulation on peripheral perfusion. Some more recent studies have already started focusing on the problem of patient selection for SCS in PVD.
Discussion
There is good evidence for the use of spinal cord stimulation for peripheral vascular disease, but the high treatment costs impede a broader application. Numerous options exist to overcome this problem. Apart from reduction of implant and procedure costs, improved patient selection based on well-established, ideally objective measurements is likely the key to open this technique for the widespread use. Additionally, ways should be investigated to increase the overall responder rates e.g. by means of other stimulation paradigms.
Conclusions
As there is sufficient evidence on the overall efficacy, future studies on spinal cord stimulation for peripheral vascular disease should focus on improving patient selection and overall responder rates.
