title: Lumbar neurolytic sympathetic blockades provide immediate and long-lasting improvement of painless walking distance and muscle metabolism in patients with severe peripheral vascular disease.
abstract: 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.
authors.affiliation: Clinic of Anesthesiology and Intensive Care Medicine, Christian-Albrechts University, Kiel, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gleim
authors.forename: C
authors.initials: C
authors.lastname: Maier
authors.forename: U
authors.initials: U
authors.lastname: Melchert
mesh_terms: 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
chemical_list: D000431:Ethanol