Asif Mehmud Janjua, Eitezaz Ahmed Basheer.
Outcome of Lumbar Sympathectomy for peripheral vascular disease.
Pak Armed Forces Med J Jan ;57(3):182-8.

Objective: To analyse the results of sympathectomy in cases of Peripheral Vascular Disease (PVD) in lower limbs. Design: A quasi-experimental study. Place and Duration of Study: The study was carried out at CMH Rawalpindi from June 1998 to June 2001. Patients and Methods: In this study, 37 patients of PVD of lower limbs, irrespective of age and sex were evaluated. Lumbar sympathectomy was undertaken unilaterally in 29 (78.4%) patients, while in 08 (21.6%) patients bilateral procedure was carried out.. Patients with advanced disease 05 in number underwent conservative amputation of toes. Sympathectomy in each case was performed with standard technique and findings were recorded. Post operatively, all lumbar ganglia removed were sent for histopathological confirmation. Cases of PVD in which reconstructive surgery was not possible because of diffuse segmental nature of the occlusive lesion coupled with frequent lack of distal target vessel were included in this study. Results: Of the 37 patients, 34 (91.9%) were males and 3 (8.1%) females, their mean age being 33.34 years. Rest Pain followed by intermittent claudication was the main mode of presentation. Indigenous cigarette smokers were 30 (81.1%) patients and 09 (24.3%) patients were diabetic. Out come measures based on subjective and objective improvements. Lumbar sympathectomy showed full recovery in 26 (70.37%) patients, marked improvement in 02 (5.4%) & no improvement in 09 (24.3%) cases. Only in 02 (5.4%) patients wound infection noticed, while no recurrence noticed during one year follow up. Conclusion: Cases of PVD in which reconstructive vascular surgery is not feasible, sympathectomy has particular use for limb pain relief, ulcer healing and in avoiding or delaying limb amputation.

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