title: Distal thigh/arm index as a predictor of success for lumbar sympathectomy.
abstract: Data from 90 lumbar sympathectomies were reviewed to assess the role of a distal thigh/arm Doppler systolic index (DTAI) and of external magnetic flowmeter (MCBF) measurements for predicting patient outcome following lumbar sympathectomy. The presenting symptoms included impending gangrene, gangrene, rest pain, nonhealing ulcers, and disabling claudication. Of the 90 cases, clinical improvement occurred in 57% of the limbs. Major amputation was not required in 73% of the limbs. The MCBF data showed variability which masked the relationship to the effects of sympathectomy. DTAI test results were significantly related to outcome. For DTAI > 0.6 (57 patients), improvement occurred in 70% of the limbs, with major amputation not required in 86% of the limbs. For DTAI < 0.6 (33 patients), improvement occurred in only 33% of the limbs, and major amputation was not required in 52% of the limbs. The Doppler systolic index has provided a noninvasive measure that can be used in conjunction with good clinical judgment for predicting the outcome of lumbar sympathectomy.
authors.affiliation: Surgical Service, Department of Veterans Affairs Medical Center, Castle Point, NY 12511.
authors.forename: B Y
authors.initials: BY
authors.lastname: Lee
authors.forename: L E
authors.initials: LE
authors.lastname: Ostrander
authors.forename: G
authors.initials: G
authors.lastname: Aquino-Chu
authors.forename: R E
authors.initials: RE
authors.lastname: Madden
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001132:Arm / Q000098:blood supply*; D001157:Arterial Occlusive Diseases / Q000145:classification* / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity; D001794:Blood Pressure; D006801:Humans; D008161:Lumbosacral Region; D011379:Prognosis; D011673:Pulsatile Flow; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013562:Sympathectomy; D013599:Systole; D013848:Thigh / Q000098:blood supply*; D016896:Treatment Outcome; D014463:Ultrasonography