Some Researches on the Peri-Arterial Sympathetics*

Lumbar Sympathectomy: Historical Perspective and Current Role

“…Rarely, lumbar sympathectomy may help in cases of incipient gangrene if the pathological changes in blood vessels are not too severe. Lumbar sympathectomy may be considered for patients with ischemic rest pain or ischemic ulceration who meet the following criteria, as recommended by Rutherford15: (1) an ankle-brachial index greater than 0.3; (2) superficial tissue necrosis confined to the forefoot or the digits; (3) absence of neuropathy on physical examination; (4) symptom relief or increased plethysmographic amplitude following lumbar sympathetic blockade; and (5) acceptable surgical risk for abdominal operation. Lumbar sympathectomy may also be used as an adjunct to improve early graft patency for distal reconstructive procedures in patients with poor runoff or hypoplastic vessels.…”

“…In the late 1930s Livingston 15 proposed that there was a &dquo;vicious cycle of reflexes&dquo; in causalagia consisting of three components: (1) chronic irritation of a peripheral sensory nerve with increasingly frequent afferent impulses; (2) abnormal (heightened) activity in the &dquo;internuncial pool&dquo; in the anterior horn of the spinal cord; and (3) increase in efferent (sympathetic) activity. This theory was supported experimentally by Toennie's demonstration that individual stimulation of over one-third of the afferent fibers of a cat's saphenous nerve resulted not only in related impulses cephalad from the spinal center but also in impulses back down efferent fibers, including sympathet-1CS.…”

Lumbar Sympathicolysis in Patients with Severe Peripheral Artery Disease: Hemodynamics of the Lower Limbs Determined by Near-Infrared Spectroscopy, Color Coded Duplex Sonography, and Temperature Measurement

“…The vessel-dilating effect of sympathetic denervation has been known for many years. [3][4][5] In CT-guided lumbar sympathicolysis, the image-guided chemical neurolysis of the sympathetic chain is performed at the level of the third lumbar vertebral body. 6 Sympathetic denervation leads to a relaxation of the vascular muscles to vasodilation and to an increase in blood flow.…”

Discussion: Neurectomy of the Nerve of Henle Associated with Periarterial Sympathectomy for Management of Intractable Raynaud Phenomenon

“…Segmental periarterial sympathectomy to femoral and axillary arteries in the early twentieth century had good initial results, but in 1921 Leriche published analysis of late failures in these patients, believing segmental sympathectomy allowed nerve growth to bypass the operative site. 8 Experimental studies suggest that adrenergic response is completely eliminated only at the adventectomy site. 9 This encourages adventectomy without skip areas where the nerve can regenerate and bypass, accomplished by in-continuity stripping.…”