Lumbar neurolytic sympathetic blockades provide immediate and long-lasting improvement of painless walking distance and muscle metabolism in patients with severe peripheral vascular disease.
Thirty patients with angiographically proven peripheral vascular disease (PVD) and intermittent claudication were treated with percutaneous lumbar neurolytic sympathetic blockade (NSB) using 1.5 mL ethanol 95%. Claudication had been progressive in all patients during conservative treatment. Median (range) painless walking distance increased from 95 (10-200) meters (m) before to 355 (25-1003) m immediately after NSB. Further improvement was seen during the 1-year follow-up, with two exceptions: one patient lost a leg after acute arterial embolism and another patient deteriorated after 6 months. In the latter case, a second NSB improved the walking distance again. One case of transient mild neuralgia of the L3 dermatome occurred. 31P-magnetic resonance investigations of the calf muscles before, during, and after a treadmill exercise were performed in seven patients: 1 week after NSB, the postexercise recovery of phosphocreatine was accelerated in all patients compared to the pre-NSB values. The accelerated recovery suggests an improved post-ischemic metabolic situation after chemical sympathectomy.
Gleim
M
M
Clinic of Anesthesiology and Intensive Care Medicine, Christian-Albrechts University, Kiel, Germany.
Maier
C
C
Melchert
U
U
D000368:Aged; D000369:Aged, 80 and over; D001340:Autonomic Nerve Block / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000378:metabolism*; D010166:Palliative Care; D016491:Peripheral Vascular Diseases / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D013116:Spinal Cord / Q000187:drug effects / Q000503:physiopathology*; D016138:Walking
D000431:Ethanol