Introduction
Refractory angina pectoris (RAP) and peripheral vascular disease (PVD) is a chronic pain condition caused by occlusive artery diseases. Since 1976 spinal cord stimulation (SCS) appears to be an effective and safe treatment for these patients - many studies have shown an excellent effect of SCS on pain relief, as illustrated by the reduction in the need for oral analgesics and improvement in patients' quality of life. Besides, it can improve microcirculatory function.
Materials / Methods
We conducted a prospective analysis of patients with non-reconstructable RAP (n=21) and PVD (n=58) who underwent SCS in our facility between 2012 and 2018. Preoperative and follow-up myocardium perfusion scintigraphy (MPS), transcutaneous oximetry (TCO) and laser-doppler flowmetry (LDF) were performed on admission and in 1 year after the procedure. Pain relief was assessed by visual analog scale (VAS) in all patients.
Results
The patients showed 9,37±0,13 marks according to VAS before the procedure and pain relief to 1,27±0,09 marks (p<0,01) in 1-year follow-up. All the patients in the RAP group demonstrated the rise of tolerance to the physical activity. MPS detected the decrement of perfusion's defect from 13,36±4,16 to 10,14±3,35 units (increase in coronary reserve up to 24%). TCO detected the microcirculatory improvement (n=56): tissue oxygenation increased from 10,5 to 39,5 mm Hg (p=0,045). There was 2 patient (3.4%) who had required postoperative amputation and 1 patient's death from cardiac infarction.
Discussion
The present study has some limitations: the follow-up period was relatively short, leading to a limited evaluation of the outcome of SCS. Measurements weren't used to select patients for SCS, since we intended to include this indicator as a factor that could potentially influence the clinical dynamics after this procedure. The approaches to the treatment of these diseases need to be optimized to timely use of surgical and nonsurgical therapy, including SCS, in order to improve clinical and cost-effectiveness.
Conclusions
The duration of clinical manifestations of RAP and PVD is associated with the long-term results of SCS. Our experience confirms that SCS can reduce the pain and improve quality of life with vascular reserve enhancement in patients with ischemic pain syndrome.

SPINAL CORD STIMULATION FOR ISCHEMIC PAIN: MICROCIRCULATION IMPROVEMENT