Lumbar sympathectomy as isolated technique for the treatment of lower limbs chronic ischemia.
BACKGROUND
Lumbar sympathectomy (LS) is often the only alternative treatment that can be considered as a means of improving the distal circulation to such extent that major amputation is prevented. To make a retrospective study in order to know the current value of LS as isolated technique for the treatment of severe ischemia of lower limbs in the absence of the possibility for vascular reconstruction.


METHODS
Between 1987 and 1992, 100 LS were performed in 93 patients (82 males and 11 females) aged 64.5+/-11.1 yrs. 63% were older than 70 years. Indication was invalidant claudication/rest pain (grade II, 57%) or trophic lesion (grade III, 43%) in patients where previous reconstructive surgery failed (18%), was not possible to do (23%) or refused revascularization (20%), or with poor surgical risk (39%). Preoperative evaluation included Doppler measures, ankle/brachial index (ABI) and arteriography in every case. Surgical sympathectomy was performed in all patients. Success was considered if rest pain was absent or trophic lesions have healed at six months, comparing results in patients diabetics and non-diabetics with ABI higher or lower 0.3.


RESULTS
Postoperative stage was 6.4+/-2.3 days. Morbidity was 4% and mortality was 7% in the 30-day postoperative period, related with patients older than 70 years. Long-term mortality was 9%, for a global nortality of 16%. 12 patients needed inflow surgery after LS. There was success in 58.5% of grade II and 61.7% of grade III patients at six months, with significative difference (p=0.049) if ABI was >0.3. In diabetics with ABI >0.3, trophic lesions have worse prognostic than ABI <0.3. Pre- and postoperative ABI were correlated (R2=0.65), and the increasing of 0.1 in preoperative ABI had a positive prognostic value over lesion healing. Patency of superficial femoral artery (SFA) has correlated significantly (p=0.000021) with successful outcome after LS.


CONCLUSIONS
LS could be a technique that moderately improves the ischemic limb in patients who refuse major surgery or where arterial reconstruction is not indicated. Preoperative ABI has prognostic value in postoperative outcome, with clinical improvement if it is >0.3. Diabetes has not been a negative predictive factor in our series. Patency of superficial femoral artery is related to successful outcome of the patients.
Perez-Burkhardt
J L
JL
Section of Vascular Surgery, Hospital Universitario de Canarias, S/C Tenerife, Spain.
Gonzalez-Fajardo
J A
JA
Martin
J F
JF
Carpintero Mediavilla
L A
LA
Mateo Gutierrez
A M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013562:Sympathectomy; D016896:Treatment Outcome; D014654:Vascular Patency