[Comparative analysis of lower extremities tissue perfusion by the use of perfusion scintigraphy method after hyperbaric oxygenation and lumbar sympathectomy].
OBJECTIVE
Lumbar sympathectomy (LS) increases pheripheral blood flow primarily by the arteriolar vasodilatation within the skin vascular net. Increase in tissue nutrition takes place only in the distal blood vessels of the skin. Nevertheless, in some patients sympathectomy brings about improvement in ischemic ulcerations healing. Hyperbaric oxigenation (HBO) is a medical treatment in which a patient breathes 100% oxygen under pressure higher than atmospheric implemented in special units allowing the whole body be in a chamber. The aim of the study was to determine efficacy of the applied therapies for the treatment of inoperable occlussive lower extremities (LE) arteries diseases according to the obtained results.


METHODS
The study included 30 patients divided into two grups (15 patients each) in which stenosis level of the lower extremities arteries had been determined using aortography due to further treatment with HBO and LS. All the patients were clinically examined, their objective condition evaluation based on claudication distance, pain in rest, skin and skin adnexa atrophy, and temperature and LE functionality, as well as exposed to perfusion scintigraphy prior to the treatment and within 30 days after the treatment finishing.


RESULTS
Analysing patients' status prior to and after the treatments applied the number of patients with obvious improvement was higher in those treated by HBO than those treated by LS. Measuring claudication distance revealed significantly greater changes in patients treated by HBO (from 178.57 m to 754.76 m) than in those treated by LS (from 229 m to 253 m). Other clinical symptoms, such as parasthesia, status of the skin adnexes (hair, nails), skin colour and temperature were also improved after the treatment by HBO.


CONCLUSIONS
The results obtained in this study confirm the advantages of HBO over LS in therapy of inoperable occlussive LE disease, so LS could be definitely abandoned as a choice for treating such disease.
Zoranović
Uros
U
Vojnomedicinska akademija, Klinika za vaskularnu hirurgiju, Beograd, Srbija.
Jevtić
Miodrag
M
Jovanović
Milan
M
Pucar
Dragan
D
Cizmić
Milica
M
D006801:Humans; D006931:Hyperbaric Oxygenation; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008160:Lumbosacral Plexus / Q000601:surgery*; D055420:Perfusion Imaging; D013562:Sympathectomy