RESUMEN
Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculatory blood flow, relieve ischemic pain and reduce amputation rate in patients with severe peripheral arterial occlusive disease (PAOD). In this article, the theories attempting to explain the mechanisms of SCS vasoactive action are presented. Our method of patient screening and our surgical technique for SCS implantation are described. In addition, the various published series reporting on the efficacy of SCS in PAOD are critically reviewed. The contemporary reports demonstrate the efficacy of SCS in ischemic pain relief. In the light of these results and our own experience, we conclude with an appraisal of modern techniques for assessing critical limb ischemia.
Asunto(s)
Terapia por Estimulación Eléctrica , Isquemia/patología , Isquemia/terapia , Extremidad Inferior/fisiopatología , Médula Espinal/efectos de la radiación , Electrodos Implantados , Humanos , Metaanálisis como Asunto , Enfermedades Vasculares Periféricas/complicaciones , Médula Espinal/fisiologíaRESUMEN
AIM: Recently whole-body 3D MR angiography (MRA) with blood-pool contrast agent has become available. The purpose of this study was to introduce and evaluate this technique to demonstrate arterial steno-occlusive involvement in systemic atherosclerosis and to compare blood-pool enhanced MRA results with those of CT angiography (CTA) as reference modality. METHODS: Twenty patients with clinically and US documented carotid occlusive disease underwent whole-body MRA on a 1.5 T scanner and CTA on a 64-MDCT unit. Ten milliliters of a blood-pool agent (MS-235 Gadofosveset Trisodium, VASOVIST, Schering, Berlin, Germany) were administered intravenously and four 3-D MRA stations were acquired successively through automatic table moving. Images were reviewed by two observers. Overall image quality of each arterial segment was assessed and rated for both MRA and CTA examinations; MRA sensitivity, MRA specificity interobserver and intermodality agreement were calculated. RESULTS: Whole-body MRA with blood-pool contrast agent was well tolerated by all patients. It yielded a detailed display of the arterial system with a short examination time. In 14 out of 20 patients there was extensive involvement of the arterial bed by steno-occlusive atherosclerotic disease; for the identification and characterization of vessel damage in the various vascular districts MRA sensitivity was 92-100%, MRA specificity was 95-100%; in 2 cases MRA underestimated the degree of peripheral vessel stenosis. Interobserver agreement calculated with K value was 0.63, intermodality agreement with CTA was 93% (P<0.01). CONCLUSION: The whole-body MRA technique is a valuable tool for comprehensive evaluation of arterial steno-occlusive involvement in systemic arterial atherosclerosis; there is a good agreement between blood-pool enhanced MRA results and CTA, used as modality of reference.