Computed tomography fluoroscopy-guided chemical lumbar sympathectomy: simple, safe and effective.
Demographic, clinical and laboratory data were retrospectively collected from records of 146 cases of CT fluoroscopy-guided chemical lumbar sympathectomy for the palliation of inoperable peripheral vascular disease (PVD) between January 1997 and August 1999. Of these, 16% had claudication, 39% had rest pain and 44% had ischaemic ulcers or gangrene. Seventy-three percent of elective cases were outpatients. At 3 months, 27 cases were lost to follow up, leaving 119 cases. Within 3 months, improvement, defined as doubling of the walking distance, cessation of rest pain or healing of ulcers, occurred in 30.3% of cases. No change was observed in 45.4% of cases and 24.3% of cases deteriorated. Patients with ulcers or gangrene had significantly poorer results than those without any ischaemic lesions, as only 19% versus 39% of patients improved (P < 0.05). The presence of hypertension, diabetes mellitus, hyperlipidaemia and smoking had no value in predicting clinical outcome (P > 0.05). There were no major complications noted. CT fluoroscopy-guided chemical lumbar sympathectomy is safe and effective, with a complication rate of less than 1%, and efficacy of at least 30% measured within 3 months. It is a simple and minimally invasive procedure, easily performed on an outpatient basis. CT fluoroscopy-guided chemical lumbar sympathectomy should be considered for all patients in the early stages of inoperable PVD.
Tay
Victoria K M
VK
University of Adelaide Medical School, North West Adelaide Health Service, The Queen Elizabeth Hospital Campus, Adelaide, South Australia, Australia.
Fitridge
Robert
R
Tie
Mark L H
ML
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008161:Lumbosacral Region / Q000294:innervation; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013563:Sympathectomy, Chemical / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome