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. 1988 Feb;207(2):179–183. doi: 10.1097/00000658-198802000-00011

Epidural spinal cord electrical stimulation improves microvascular blood flow in severe limb ischemia.

M J Jacobs 1, P J Jörning 1, S R Joshi 1, P J Kitslaar 1, D W Slaaf 1, R S Reneman 1
PMCID: PMC1493372  PMID: 3257679

Abstract

Epidural spinal cord electrical stimulation (ESES) was performed on 10 patients with severe limb ischemia due to atherosclerotic disease. Microcirculatory parameters were assessed before and after ESES. Bright field microscopy was used to assess capillary diameters and red blood cell (RBC) velocity in the dorsum of the foot. Fluorescein microscopy was used with intravenously injected sodium fluorescein to study capillary density and sodium fluorescein appearance time in the dorsum of the toe. The systolic ankle/arm pressure ratio and toe pressure measurements were used as macrocirculatory parameters. After ESES, clinical improvement was confirmed by intravital microscopy. Capillary density increased (p less than 0.001), RBC velocity in capillaries already perfused before ESES increased from 0.054 mm/sec to 0.762 mm/sec (p less than 0.001), and sodium fluorescein appearance time decreased from 72 to 45 seconds (p less than 0.001). Capillary diameter did not change significantly so that the increase in RBC velocity may be interpreted as enhanced volume flow. Systolic ankle/arm pressure ratios and digital arterial pressure did not change significantly. The current results show that in patients with severe occlusive arterial disease of the lower limbs, ESES recruits capillaries not perfused in the control situation and enhances skin blood flow, improvements that may explain the beneficial clinical effects of ESES.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Augustinsson L. E., Carlsson C. A., Fall M. Autonomic effects of electrostimulation. Appl Neurophysiol. 1982;45(1-2):185–189. doi: 10.1159/000101596. [DOI] [PubMed] [Google Scholar]
  2. Augustinsson L. E., Carlsson C. A., Holm J., Jivegård L. Epidural electrical stimulation in severe limb ischemia. Pain relief, increased blood flow, and a possible limb-saving effect. Ann Surg. 1985 Jul;202(1):104–110. doi: 10.1097/00000658-198507000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bollinger A., Butti P., Barras J. P., Trachsler H., Siegenthaler W. Red blood cell velocity in nailfold capillaries of man measured by a television microscopy technique. Microvasc Res. 1974 Jan;7(1):61–72. doi: 10.1016/0026-2862(74)90037-5. [DOI] [PubMed] [Google Scholar]
  4. Broseta J., Barberá J., de Vera J. A., Barcia-Salorio J. L., Garcia-March G., González-Darder J., Rovaina F., Joanes V. Spinal cord stimulation in peripheral arterial disease. A cooperative study. J Neurosurg. 1986 Jan;64(1):71–80. doi: 10.3171/jns.1986.64.1.0071. [DOI] [PubMed] [Google Scholar]
  5. Clyne C. A. Non-surgical management of peripheral vascular disease: a review. Br Med J. 1980 Sep 20;281(6243):794–797. doi: 10.1136/bmj.281.6243.794. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Collins G. J., Jr, Rich N. M., Clagett G. P., Salander J. M., Spebar M. J. Clinical results of lumbar sympathectomy. Am Surg. 1981 Jan;47(1):31–35. [PubMed] [Google Scholar]
  7. Cook A. W., Oygar A., Baggenstos P., Pacheco S., Kleriga E. Vascular disease of extremities. Electric stimulation of spinal cord and posterior roots. N Y State J Med. 1976 Mar;76(3):366–368. [PubMed] [Google Scholar]
  8. Dooley D. M., Kasprak M. Modification of blood flow to the extremities by electrical stimulation of the nervous system. South Med J. 1976 Oct;69(10):1309–1311. doi: 10.1097/00007611-197610000-00017. [DOI] [PubMed] [Google Scholar]
  9. Fagrell B. Vital capillary microscopy. A clinical method for studying changes of the nutritional skin capillaries in legs with arteriosclerosis obliterans. Scand J Clin Lab Invest Suppl. 1973;133:2–50. [PubMed] [Google Scholar]
  10. Fiume D. Spinal cord stimulation in peripheral vascular pain. Appl Neurophysiol. 1983;46(5-6):290–294. doi: 10.1159/000101276. [DOI] [PubMed] [Google Scholar]
  11. Gregg R. O. Bypass or amputation? Concomitant review of bypass arterial grafting and major amputations. Am J Surg. 1985 Mar;149(3):397–402. doi: 10.1016/s0002-9610(85)80117-3. [DOI] [PubMed] [Google Scholar]
  12. Hilton S. M., Marshall J. M. Dorsal root vasodilatation in cat skeletal muscle. J Physiol. 1980 Feb;299:277–288. doi: 10.1113/jphysiol.1980.sp013124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jacobs M. J., Breslau P. J., Slaaf D. W., Reneman R. S., Lemmens J. A. Nomenclature of Raynaud's phenomenon: a capillary microscopic and hemorheologic study. Surgery. 1987 Feb;101(2):136–145. [PubMed] [Google Scholar]
  14. Long D. M. Electrical stimulation for the control of pain. Arch Surg. 1977 Jul;112(7):884–888. doi: 10.1001/archsurg.1977.01370070098016. [DOI] [PubMed] [Google Scholar]
  15. Meglio M., Cioni B., Dal Lago A., De Santis M., Pola P., Serricchio M. Pain control and improvement of peripheral blood flow following epidural spinal cord stimulation: case report. J Neurosurg. 1981 Jun;54(6):821–823. doi: 10.3171/jns.1981.54.6.0821. [DOI] [PubMed] [Google Scholar]
  16. Melzack R., Wall P. D. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971–979. doi: 10.1126/science.150.3699.971. [DOI] [PubMed] [Google Scholar]
  17. Owens S., Atkinson E. R., Lees D. E. Thermographic evidence of reduced sympathetic tone with transcutaneous nerve stimulation. Anesthesiology. 1979 Jan;50(1):62–65. doi: 10.1097/00000542-197901000-00018. [DOI] [PubMed] [Google Scholar]
  18. Slaaf D. W., Tangelder G. J., Reneman R. S., Jäger K., Bollinger A. A versatile incident illuminator for intravital microscopy. Int J Microcirc Clin Exp. 1987 Dec;6(4):391–397. [PubMed] [Google Scholar]
  19. Tallis R. C., Illis L. S., Sedgwick E. M., Hardwidge C., Garfield J. S. Spinal cord stimulation in peripheral vascular disease. J Neurol Neurosurg Psychiatry. 1983 Jun;46(6):478–484. doi: 10.1136/jnnp.46.6.478. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Tyml K., Ellis C. G. Evaluation of the flying spot technique as a television method for measuring red cell velocity in microvessels. Int J Microcirc Clin Exp. 1982;1(2):145–155. [PubMed] [Google Scholar]

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