Use of Lumbar Sympathectomy as an Adjunct to Reconstructive Arterial Surgery *

Weismann, Rodger E.; Upson, James F.

doi:10.1097/00000658-196111000-00002

Cited by 13 publications

(3 citation statements)

References 7 publications

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“…Others, however, have claimed that flow rates are already maximal after a successful reconstruction and that sympathectomy is an unnecessary addition (Sumner and Folse, 1968;Strandness and Sumner, 1975). Clinical studies have also produced conflicting results (Cannon et al, 1961 ;Weismann and Upson, 1961), and although additional sympathectomy may be of value when there is significant disease in the belowknee vessels (Gillespie, 1973), the case for its widespread use in aorto-iliac surgery remains unproved (Szilagyi et al, 1967).…”

Section: Discussionmentioning

confidence: 99%

The role of the profunda femoris in aorto-iliac surgery

Ward

Morris-Jones²

1978

British Journal of Surgery

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The results of aorto-iliac surgery in 90 ischaemic limbs (68 patients) have been reviewed. The mean follow-up period was 18 months (range 6 months to 3: years). In 48 limbs the disease was confined to the aorto-iliac segment (group I ) , while in 42 limbs severe occlusive changes were present in both the aorto-iliac and superficial femoral segments (group 2).In group I intermittent claudication was abolished or substantially improved in 86 per cent. Rest pain was relieved in all cases. Lumbar sympathectomy was without obvious additional benefit in either group. Pedal pulses were restored in all except 3 limbs. A highly signifcant (P< 0.001) increase in the ankle systolic pressure (ASP) index occurred after surgery and normal values were restored both in claudicants and in those with rest pain. This response was maintained throughout the follow-up period.Claudication was eflectively relieved in 38 per cent of cases in group 2 following aortoprofunda reconstruction. Rest pain was abolished in 83 per cent of cases, the remainder requiring a major amputation. Lumbar sympathectomy failed to produce any additional benefit among either claudicants or those with rest pain. Pedal pulses were restored in only 2 limbs. Among claudicants the ASP index was unchanged, and although a significant (P< 0.001) increase occurred in the rest pain group, the index remained within the ischaemic range. There was little variation in the value of the ASP index throughout the follow-up period in either group. The difference between the ASP response to surgery in patients with aorta-iliac disease alone and those with dual occlusion was highly signifcant (P< 0.001).The present results suggest that among claudicants revascularization of the profunda alone may be followed by a limited clinical and haemodynamic response. However, as a limb salvage procedure, aortoprofunda reconstruction can be recommended with confidence. When both the superficial and deep femoral vessels are patent, an excellent response is to be expected after aorto-iliac surgery in claudicants and patients with rest pain alike.

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Section: Discussionmentioning

confidence: 99%

The role of the profunda femoris in aorto-iliac surgery

Ward

Morris-Jones²

1978

British Journal of Surgery

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“…21 Par ailleurs, une rSponse positive nous permettrait peut 4tre de juger de ravantage de faire une sympathectomie en m4me temps que l'angioplastic. 26 Nous avons quand m~me dans notre s6rie sept malades qui ont d6j~t eu des grettes f6moro-poplit6es et qui ont subi par la suite une sympathectomie pour troubles vasculaires. Une hypoxie tissulaire prolong6e am6ne-t-elle une d6g~n6-rescence de la fibre sympathique et cette d6g~n6rescence est-elle r6versible apr6s r6instauration d'une perfusion ad6quate?…”

Section: Analyses Globales ( Tableau Ix)unclassified

Le reflexe sympatho-galvanique (RSG) et la sympathectomie

Boucher

Falardeau

Plante

et al. 1970

Can. Anaesth. Soc. J.

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“…Protection of the distal extremity in the event of early or late failure of the arterial reconstruction. 5. Lowered level of amputation, if such becomes necessary following arterial reconstruction.…”

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confidence: 99%