Spinal cord stimulation for patients with critical limb ischemia: immediate and long-term clinical outcome from the prospective italian register.

The Prospective Italian Register of spinal cord stimulation (SCS) was designed to evaluate the clinical outcome of patients with severe peripheral arterial occlusive disease (PAOD) treated with SCS. Baseline data were collected for all patients with PAOD undergoing SCS treatment (September 1998 to February 2001) at 34 participating centers. If, after a 2- to 3-week trial, SCS demonstrated significant clinical benefits, a permanent implantable pulse generator was implanted. Follow-up data were evaluated at 4, 8, and 12 months postimplantation. Overall, 250 patients (176 men, 74 women) were enrolled (mean age 72.6 ± 17 years) and classified by Fontaine stage. In total, 77.6% (194/250) of patients received a permanent implant and 43.6% (109/250) reached 1 year of follow-up. Fontaine stage, pain relief, free-walking interval, and drug intake improved significantly during follow-up. Age and Fontaine stage were significantly associated with major amputation. Cumulative limb survival at 1 year for the subgroup of Fontaine stage III patients was 82.2%. The mean number of hospital admissions and stay duration at 1 year postimplantation was significantly reduced compared with 1 year preimplant: 1.5 vs. 0.6 admissions and 27 vs. 6 days, respectively. Among 109 patients evaluable at 12 months, 83 (76.1%) experienced ≥50% reduction in pain. All PAOD parameters improved significantly during follow-up. At 12 months postimplantation, 76.1% of patients were responsive to SCS therapy. The reduction in the use of analgesics and the number and duration of hospital stays offers clear economic advantages.

Renal anomalies in aortic surgery: contemporary results.

OBJECTIVE: The purpose of this study was to evaluate technical problems and results of surgical treatment of aortic disease associated with major renal anomalies. STUDY DESIGN: Renal anomalies observed during aortic procedures performed over a 19-year period were reviewed. Type of renal anomaly, diagnostic procedures, preoperative renal function, technique of vascular reconstruction, and management of the anomalous kidney were considered and correlated with peri-operative and long-term results. RESULTS: Eighteen patients (1.1%) with major renal abnormalities were found in our experience with more than 1650 aortic procedures. Of these, 10 involved horseshoe kidneys and 8 ectopic kidneys (3 pelvic, 3 lumbar, and 2 crossed ectopias). All elective cases were evaluated with computed tomography, urography, and angiography. Aortic reconstruction was performed in 17 patients for aortic aneurysm (1 urgent repair for rupture) and in 1 patient for obstructive disease. Surgical access was anterior transperitoneal in 16 patients and retroperitoneal/thoracoabdominal in 2. In 8 patients, reimplantation of 1 or both renal arteries was necessary. Division of the renal isthmus was necessary in 3 patients with horseshoe kidney. The perioperative mortality rate was 0%. Renal function was normal at discharge in all patients. At long-term follow-up (median, 5 years; range, 1 to 19 years) neither renal nor aortic complications were detected. In 15 of 17 patients, the aneurysm was confined to the abdominal aorta. CONCLUSION: Although infrequent, renal anomalies encountered during aortic surgery can be effectively treated with accurate diagnosis and preoperative planning.