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Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia
Background: Spinal cord stimulation (SCS) may have a place in the treatment of patients with inoperable chronic critical leg ischaemia. Methods: A systematic review and meta‐analysis was performed of all controlled studies comparing SCS in addition to any form of conservative treatment for inoperabl...
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| Published in: | British journal of surgery 2004-08, Vol.91 (8), p.948-955 |
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| container_end_page | 955 |
| container_issue | 8 |
| container_start_page | 948 |
| container_title | British journal of surgery |
| container_volume | 91 |
| creator | Ubbink, D. T. Vermeulen, H. Spincemaille, G. H. J. J. Gersbach, P. A. Berg, P. Amann, W. |
| description | Background:
Spinal cord stimulation (SCS) may have a place in the treatment of patients with inoperable chronic critical leg ischaemia.
Methods:
A systematic review and meta‐analysis was performed of all controlled studies comparing SCS in addition to any form of conservative treatment for inoperable chronic critical leg ischaemia. Main endpoints were limb salvage, pain relief and clinical situation. Systematic methodological appraisal and data extraction were performed by independent reviewers.
Results:
Of the 18 reports found, nine trials, comprising 444 patients, matched the selection criteria. After pooling, limb salvage at 12 months appeared significantly greater in the SCS group (risk difference (RD) − 0·13 (95 per cent confidence interval (c.i.) − 0·04 to − 0·22)). Significant pain relief occurred in both treatment groups, but patients who received SCS required significantly less analgesia and reached Fontaine stage 2 more often than those who did not have SCS (RD 0·33 (95 per cent c.i. 0·19 to 0·47)). Complications of SCS were problems of implantation (8·2 per cent), changes in stimulation requiring reintervention (14·8 per cent) and infection (2·9 per cent).
Conclusion:
The addition of SCS to standard conservative treatment improves limb salvage, ischaemic pain and the general clinical situation in patients with inoperable chronic critical leg ischaemia. These benefits should be weighed against the cost and the (minor) complications associated with the technique. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Better than conservative treatment alone |
| doi_str_mv | 10.1002/bjs.4629 |
| format | article |
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Spinal cord stimulation (SCS) may have a place in the treatment of patients with inoperable chronic critical leg ischaemia.
Methods:
A systematic review and meta‐analysis was performed of all controlled studies comparing SCS in addition to any form of conservative treatment for inoperable chronic critical leg ischaemia. Main endpoints were limb salvage, pain relief and clinical situation. Systematic methodological appraisal and data extraction were performed by independent reviewers.
Results:
Of the 18 reports found, nine trials, comprising 444 patients, matched the selection criteria. After pooling, limb salvage at 12 months appeared significantly greater in the SCS group (risk difference (RD) − 0·13 (95 per cent confidence interval (c.i.) − 0·04 to − 0·22)). Significant pain relief occurred in both treatment groups, but patients who received SCS required significantly less analgesia and reached Fontaine stage 2 more often than those who did not have SCS (RD 0·33 (95 per cent c.i. 0·19 to 0·47)). Complications of SCS were problems of implantation (8·2 per cent), changes in stimulation requiring reintervention (14·8 per cent) and infection (2·9 per cent).
Conclusion:
The addition of SCS to standard conservative treatment improves limb salvage, ischaemic pain and the general clinical situation in patients with inoperable chronic critical leg ischaemia. These benefits should be weighed against the cost and the (minor) complications associated with the technique. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Better than conservative treatment alone</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.4629</identifier><identifier>PMID: 15286954</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Ankle - blood supply ; Biological and medical sciences ; Critical Illness ; Electric Stimulation Therapy - adverse effects ; Electric Stimulation Therapy - economics ; Electric Stimulation Therapy - methods ; General aspects ; Humans ; Ischemia - economics ; Ischemia - physiopathology ; Ischemia - rehabilitation ; Leg - blood supply ; Limb Salvage ; Medical sciences ; Pain - etiology ; Pain - prevention & control ; Randomized Controlled Trials as Topic</subject><ispartof>British journal of surgery, 2004-08, Vol.91 (8), p.948-955</ispartof><rights>Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.</rights><rights>2004 INIST-CNRS</rights><rights>Copyright 2004 British Journal of Surgery Society Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3869-c54da851ee5a2927dc00c052ea8a91c2441fed72a9fea775be62ee5f772eb7673</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15965762$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15286954$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ubbink, D. T.</creatorcontrib><creatorcontrib>Vermeulen, H.</creatorcontrib><creatorcontrib>Spincemaille, G. H. J. J.</creatorcontrib><creatorcontrib>Gersbach, P. A.</creatorcontrib><creatorcontrib>Berg, P.</creatorcontrib><creatorcontrib>Amann, W.</creatorcontrib><title>Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background:
Spinal cord stimulation (SCS) may have a place in the treatment of patients with inoperable chronic critical leg ischaemia.
Methods:
A systematic review and meta‐analysis was performed of all controlled studies comparing SCS in addition to any form of conservative treatment for inoperable chronic critical leg ischaemia. Main endpoints were limb salvage, pain relief and clinical situation. Systematic methodological appraisal and data extraction were performed by independent reviewers.
Results:
Of the 18 reports found, nine trials, comprising 444 patients, matched the selection criteria. After pooling, limb salvage at 12 months appeared significantly greater in the SCS group (risk difference (RD) − 0·13 (95 per cent confidence interval (c.i.) − 0·04 to − 0·22)). Significant pain relief occurred in both treatment groups, but patients who received SCS required significantly less analgesia and reached Fontaine stage 2 more often than those who did not have SCS (RD 0·33 (95 per cent c.i. 0·19 to 0·47)). Complications of SCS were problems of implantation (8·2 per cent), changes in stimulation requiring reintervention (14·8 per cent) and infection (2·9 per cent).
Conclusion:
The addition of SCS to standard conservative treatment improves limb salvage, ischaemic pain and the general clinical situation in patients with inoperable chronic critical leg ischaemia. These benefits should be weighed against the cost and the (minor) complications associated with the technique. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Better than conservative treatment alone</description><subject>Ankle - blood supply</subject><subject>Biological and medical sciences</subject><subject>Critical Illness</subject><subject>Electric Stimulation Therapy - adverse effects</subject><subject>Electric Stimulation Therapy - economics</subject><subject>Electric Stimulation Therapy - methods</subject><subject>General aspects</subject><subject>Humans</subject><subject>Ischemia - economics</subject><subject>Ischemia - physiopathology</subject><subject>Ischemia - rehabilitation</subject><subject>Leg - blood supply</subject><subject>Limb Salvage</subject><subject>Medical sciences</subject><subject>Pain - etiology</subject><subject>Pain - prevention & control</subject><subject>Randomized Controlled Trials as Topic</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><recordid>eNpN0cFu1DAQBmCrArVLi8QTIF_glmI7sZ0coYJCVaiqBXG0Js6kdeskiydL2RuPjlfdtpzm4E_jmfkZeyXFsRRCvWtv6LgyqtljC1kaXShp6mdsIYSwhSxVecBeEN0IIUuh1T47kFrVptHVgv1dbmjGAebgecLfAe84jB0fcIYCRogbCsSnnvtpnNMUI3Z8TgEicSBCojBecVqFLDNJHac5DOuY200j76fEwzitMEEbkfsU8i8ZRrzigfw14BDgiD3vczt8uauH7Menj99PPhfnF6dfTt6fF77MoxZeVx3UWiJqUI2ynRfC52UQamikV1Ule-ysgqZHsFa3aFS2vbUKW2tsecje3vddpenXGml2Q54BY4QRpzU5Y6yRxtQZvt7BdTtg51YpDJA27uFmGbzZAaC8Tp9g9IH-c43R1qjsint3FyJunt6F22bmcmZum5n7cLbc1icfciJ_Hj2kW5fnt9r9_HbqLpuzpbmU2n0t_wFB2Zq4</recordid><startdate>200408</startdate><enddate>200408</enddate><creator>Ubbink, D. T.</creator><creator>Vermeulen, H.</creator><creator>Spincemaille, G. H. J. J.</creator><creator>Gersbach, P. A.</creator><creator>Berg, P.</creator><creator>Amann, W.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>200408</creationdate><title>Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia</title><author>Ubbink, D. T. ; Vermeulen, H. ; Spincemaille, G. H. J. J. ; Gersbach, P. A. ; Berg, P. ; Amann, W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3869-c54da851ee5a2927dc00c052ea8a91c2441fed72a9fea775be62ee5f772eb7673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Ankle - blood supply</topic><topic>Biological and medical sciences</topic><topic>Critical Illness</topic><topic>Electric Stimulation Therapy - adverse effects</topic><topic>Electric Stimulation Therapy - economics</topic><topic>Electric Stimulation Therapy - methods</topic><topic>General aspects</topic><topic>Humans</topic><topic>Ischemia - economics</topic><topic>Ischemia - physiopathology</topic><topic>Ischemia - rehabilitation</topic><topic>Leg - blood supply</topic><topic>Limb Salvage</topic><topic>Medical sciences</topic><topic>Pain - etiology</topic><topic>Pain - prevention & control</topic><topic>Randomized Controlled Trials as Topic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ubbink, D. T.</creatorcontrib><creatorcontrib>Vermeulen, H.</creatorcontrib><creatorcontrib>Spincemaille, G. H. J. J.</creatorcontrib><creatorcontrib>Gersbach, P. A.</creatorcontrib><creatorcontrib>Berg, P.</creatorcontrib><creatorcontrib>Amann, W.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ubbink, D. T.</au><au>Vermeulen, H.</au><au>Spincemaille, G. H. J. J.</au><au>Gersbach, P. A.</au><au>Berg, P.</au><au>Amann, W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2004-08</date><risdate>2004</risdate><volume>91</volume><issue>8</issue><spage>948</spage><epage>955</epage><pages>948-955</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background:
Spinal cord stimulation (SCS) may have a place in the treatment of patients with inoperable chronic critical leg ischaemia.
Methods:
A systematic review and meta‐analysis was performed of all controlled studies comparing SCS in addition to any form of conservative treatment for inoperable chronic critical leg ischaemia. Main endpoints were limb salvage, pain relief and clinical situation. Systematic methodological appraisal and data extraction were performed by independent reviewers.
Results:
Of the 18 reports found, nine trials, comprising 444 patients, matched the selection criteria. After pooling, limb salvage at 12 months appeared significantly greater in the SCS group (risk difference (RD) − 0·13 (95 per cent confidence interval (c.i.) − 0·04 to − 0·22)). Significant pain relief occurred in both treatment groups, but patients who received SCS required significantly less analgesia and reached Fontaine stage 2 more often than those who did not have SCS (RD 0·33 (95 per cent c.i. 0·19 to 0·47)). Complications of SCS were problems of implantation (8·2 per cent), changes in stimulation requiring reintervention (14·8 per cent) and infection (2·9 per cent).
Conclusion:
The addition of SCS to standard conservative treatment improves limb salvage, ischaemic pain and the general clinical situation in patients with inoperable chronic critical leg ischaemia. These benefits should be weighed against the cost and the (minor) complications associated with the technique. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Better than conservative treatment alone</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>15286954</pmid><doi>10.1002/bjs.4629</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 2004-08, Vol.91 (8), p.948-955 |
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| language | eng |
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| source | Oxford Journals Online |
| subjects | Ankle - blood supply Biological and medical sciences Critical Illness Electric Stimulation Therapy - adverse effects Electric Stimulation Therapy - economics Electric Stimulation Therapy - methods General aspects Humans Ischemia - economics Ischemia - physiopathology Ischemia - rehabilitation Leg - blood supply Limb Salvage Medical sciences Pain - etiology Pain - prevention & control Randomized Controlled Trials as Topic |
| title | Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia |
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