CASE REPORTS  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2002 April;43(2):255-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Temporary spinal cord stimulation for peripheral cholesterol embolism

Ghilardi G., Massaro F., Gobatti D., Kunkl E., Scorza R.

From the Department of General Surgery Insitute of Medicine, Surgery and Dentistry S. Paolo Hospital University of Milan, Milan, Italy

Cholesterol embo­lism is ­often an unrec­og­nized com­pli­ca­tion of ­some car­diac and vas­cu­lar pro­ce­dures (i.e. coron­a­rog­ra­phy, angio­plas­ty, aor­to­cor­o­nary ­bypass, abdom­i­nal aor­tic aneu­rys­mec­to­my) and of ther­a­pies affect­ing coag­u­la­tion (throm­bol­y­sis, anti­co­ag­u­la­tion). The ­degree of ­pain asso­ciat­ed ­with ischaem­ic and necrot­ic ­lesions sec­on­dary to cho­les­te­rol embo­lism involv­ing the low­er ­limbs is dis­pro­por­tion­ate to the exten­sion of tis­sue involve­ment. Spinal ­cord stim­u­la­tion (SCS) has ­been rec­og­nized as effec­tive in ­relief of ­pain of ischaem­ic and neu­ro­path­ic ­nature, ­although its mech­a­nism of ­action is ­still not com­plete­ly ­clear. The ­authors are una­ware of pre­vi­ous ­reports of periph­er­al cho­les­te­rol embo­lism treat­ed by SCS. Two ­case ­reports of infe­ri­or ­limb ischae­mia sec­on­dary to cho­les­te­rol embo­lism in ­patients who had under­gone car­diac inva­sive pro­ce­dures. Temporary sur­gi­cal implan­ta­tion of SCS devic­es, ­which ­were ­removed ­after 4 to 6 ­weeks. Pain ­relief was ­achieved with­in 1 to 4 ­hours of sur­gi­cal pro­ce­dure. Any anal­ge­sic med­i­ca­tions ­could be imme­di­ate­ly dis­con­tin­ued. Pain con­trol was effec­tive and nor­mal dai­ly activ­ities ­were rap­id­ly ­regained. Ischaemic ­lesions ­healed with­in 4 to 6 ­weeks of SCS. Pain con­trol is the ­most crit­i­cal ­aspect of the man­age­ment of periph­er­al cho­les­te­rol embo­lism with­out vis­cer­al ­organ involve­ment. SCS pro­vid­ed effec­tive ­pain ­relief in the report­ed cas­es and its estab­lished abil­ity to ­improve periph­er­al micro­cir­cu­la­tion ­allowed rap­id res­o­lu­tion of necrot­ic ­lesions. Temporary SCS ­should be con­sid­ered in the man­age­ment of pain­ful necrot­ic ­skin ­lesions sec­on­dary to iat­ro­gen­ic cho­les­te­rol embo­lism.