title: Lumbar chemical sympathectomy in peripheral vascular disease: does it still have a role?
abstract: BACKGROUND
  Lumbar chemical sympathectomy (LCS) is used principally in inoperable peripheral vascular disease (PVD) to alleviate symptoms of rest pain and as an adjunct to other treatments for ulcers. No guidelines currently exist in the UK for its use in PVD. The aim of this study was to evaluate the role of LCS with regard to indications and outcomes in the UK and Irish vascular surgical practice.
  
  
  METHODS
  Specifically designed questionnaires were sent to Vascular Surgical Society members. The questions related to their current use of LCS including indications, outcome parameters, use in diabetics and complications encountered.
  
  
  RESULTS
  Four hundred and ninety postal questionnaires were sent out and 242 responses (49%) were received. Seventy five percent of the respondents (n=183) felt that LCS had a role in current practice. Seventy eight percent (n=144) performed less than 10 procedures per year and 3% (n=5) more than 20 per year. Eighty percent (n=145) were performed by anaesthetists, 12% (n=23) by radiologists and 8% (n=15) by surgeons. Inoperable peripheral vascular disease with rest pain was the main indication in over 80% of responses with 27% using it for the treatment of ulcers. Only 21% used LCS in diabetics. Clinical improvement was used to assess the outcome following LCS in 96% of responses. Complications included neuralgia, ureteric damage and paraplegia following inadvertent extradural injection.
  
  
  CONCLUSIONS
  Although no clear guidance exists for the use of LCS in PVD, the majority of respondents continue to use it. Indications and outcomes are documented in this study of UK and Irish vascular surgical practice.
authors.affiliation: Department of Vascular Surgery and Anaesthesia, Taunton and Somerset NHS Trust, Musgrove Park, Taunton TA1 5DA, United Kingdom. drbhu@hotmail.com
authors.forename: Prabhu N
authors.initials: PN
authors.lastname: Nesargikar
authors.forename: M K
authors.initials: MK
authors.lastname: Ajit
authors.forename: Paul S
authors.initials: PS
authors.lastname: Eyers
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Nichols
authors.forename: John F
authors.initials: JF
authors.lastname: Chester
mesh_terms: D006801:Humans; D007511:Ischemia / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008159:Lumbar Vertebrae; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000628:therapy*; D011795:Surveys and Questionnaires; D013563:Sympathectomy, Chemical; D006113:United Kingdom