Sympathectomy for Obliterative Arterial Disease; Indications and Contraindications

Freeman, Norman E.; Leeds, Frank H.; Gardner, Richard E.

doi:10.1097/00000658-194712000-00004

Cited by 51 publications

(9 citation statements)

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“…This paradoxical finding is probably due to a " borrowing " phenomenon, all or most of the available blood in the lower limb being short-circuited through the dilated vessels of the thigh and calf. A similar phenomenon has been noted after lumbar sympathectomy in some patients with severe ischaemia of the feet (Freeman, Leeds, and Gardner, 1947). In such cases intra-arterial vasodilator substances of any variety are clearly contraindicated.…”

Section: Discussionsupporting

confidence: 68%

Intra-arterial Oxygen in Peripheral Vascular Disease

Marshall¹,

Whelan²

1956

BMJ

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The injection of small quantities of oxygen or of various other gases into the brachial artery of the normal subject is followed by marked vasodilatation in the hand and forearm which persists for an hour or more (Duff, Greenfield, and Whelan, 1953). This observation suggested a possible application in the treatment of patients with ischaemic disorders of the limbs. Much of the disability in these patients is a direct consequence of reduced blood flow to skin and muscle, and it was felt that if vasodilatation could be obtained comparable in degree and duration to that in normal people symptomatic benefit might result. Intra-arterial oxygen has been employed as a mode of therapy in ischaemic disorders of the lower limbs by Lemaire, Loeper, and Housset (1948); they were impressed with its effect in improving symptoms. Since then several workers in Germany (Wernitz and Dorken, 1954; M. Ratschow, personal communication, 1955;Hasse, Koble, and Linker, 1955) have claimed therapeutic benefit from intra-arterial oxygen therapy. This paper presents the results of a detailed study of circulatory changes induced by intra-arterial oxygen injections in patients with peripheral arterial disease involving upper and lower limbs. The changes are compared with those following intra-arterial injection of three potent vasodilator drugs: tolazoline (" priscol "), hydrallazine (" apresoline "), and phenyl-iso-butyl-np-hydroxy ephedrine (" dilatal "). MethodsThe investigations were carried out at a room temperature of 20-24' C. The patient rested on a couch for at least an hour before observations were made. In the case of the upper limb, injections were made into the brachial artery in the antecubital fossa; for the lower limb, they were made into the femoral artery in the groin. The limb into which the injection was made was raised slightly. A continuous infusion of 0.9% saline was maintained into the artery from a mechanically driven syringe, and the gaseous oxygen was added slowly to the stream of saline through a side-arm in the connecting tubing.On most occasions measurements of blood flow were made by the technique of venous occlusion plethysmography (Barcrdft and Edholm, 1943). The segment of limb being investigated was enclosed in a water-filled mechanically stirred plethysmograph (Greenfield, 1954), the water temperature being 31-32' C. for the hand and foot, and [34][35] inflated to a pressure of 200 mm. Hg for one minute before and during the recording of calf and forearm blood flows.After each injection of oxygen or of a vasodilator drug, blood flow records were taken at frequent intervals for one and a half to three hours. If at the end of this time the blood flow was still significantly raised further observations were made at intervals until it had returned to the resting level.On some occasions changes in the skin temperature of the foot following injection were measured by a thermo-electric junction.The dose of oxygen was 10 ml. for the upper limb and 30 ml. for the lower limb, given over a period of 10 to 15 min...

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Section: Discussionsupporting

confidence: 68%

Intra-arterial Oxygen in Peripheral Vascular Disease

Marshall¹,

Whelan²

1956

BMJ

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“…A rise in temperature of 1 to 2° Celcius has been considered by many to be the minimum if lumbar sympathectomy is to be undertaken. Thus, Atlas8, Freeman et al 9 and Nyström10 maintain that in cases with less rise in temperature, or even a drop in it, the operation may have a deleterious effect and sometimes be followed by gangrene. On the other hand White and associatesll think that a good result can be predicted regardless of the effect of the lumbar ganglion block on the skin temperature.…”

Section: Discussionmentioning

confidence: 99%

Late Results in the Treatment of Peripheral Arterial Insufficiency of the Lower Leg with Lumbar Sympathectomy

Berge¹,

Johansen²

1958

Angiology

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“…One can still get poor clinical results in association with therapy that has resulted in an increase of total blood flow to an extremity (15,16). Whether repeated intra-arterial injections of Priscoline would give the lasting benefit noted in the case of intraarterial histamine by Mufson (9) is conjectural.…”

Section: Discussionmentioning

confidence: 99%