Evaluation of lumbar sympathectomy impact on the clinical course, blood flow parameters and muscle perfusion in a group of patients with peripheral arterial disease (PAD)

Background:    Occlusive arterial disease is a common disease. Frequently, at the time of diagnosis, disease severity prevents revascularization. The study evaluated lumbar sympathectomy influence on the clinical course, blood flow parameters and muscle perfusion.
    Material/Methods:    Research group included 33 patients (13 women – 39.4%, and 20 men – 60.6%) aged from 47 to 81 (mean age 63.54±8.63 years) treated for PAD and qualified to undergo lumbar sympathectomy. Physical examination, standard vascular tests (ankle-brachial, thigh-ankle and thigh-shin indices, maximum flow velocity, PI and RI in selected arteries), perfusion scintigraphy of lower limbs muscles at rest and on exertion were carried out before and 6 months after surgery.
    Results:    Statistically significant increase of total walking distance (71.82 meters vs. 177.58 meters, p <0.002) was detected. On the basis of participants feelings, the effect of treatment as a positive was declared by 30 of them, representing 90.9% of the sample. Only 2 patients (6.1%) identified treatment as not affecting their health condition, and 1 patient (3.0%) reported worsening of symptoms after treatment. Standard vascular tests and perfusion scintigraphy did not reveal any significant changes.
    Conclusions:    Lumbar sympathectomy in patients suffering from severe, atherosclerotic lower limb ischaemia brought positive effects such as increasing walking distance, decreasing rest pain or healing skin ulcers. This effect was not combined with improvement of muscle blood perfusion but with increase of pain treshhold (walking distance, rest pain) and skin blood flow (ulcer healing).

Keywords: peripheral arterial disease, limb ischaemia, LUMBAR SYMPATHECTOMY