Rashid Usman, Muhammad Jamil.
Role of operative lumbar sympathectomy in patients with critical lower limb ischemia not amenable to vascular reconstructive surgery.
J Surg Pak Jan ;21(3):83-7.

Objective: To assess the effectiveness of operative lumbar sympathectomy (LS) in patients with unreconstructable lower limb peripheral vascular disease. Study design: Cross sectional study. Place & Duration of study: Department of Vascular Surgery Combined Military Hospital (CMH) Lahore, from May 2012 to May 2015. Methodology: A total of 117 LS were performed in 105 patients fulfilling the inclusion criteria. The indications for operation were rest pain only in 61 (52.1%), rest pain with trophic changes in 24 (20.5%) and distal gangrene in 32 (27.3%) patients. Duplex scan was done and ankle brachial pressure index (ABPI) was measured preoperatively. Patients were assessed for pain using Visual Analog Scale (VAS) and improvement in trophic changes. All patients were followed up for one year documenting improvement of pain, healing of trophic lesions and / or amputations. Results: At 6 weeks postoperatively, 85 (72.6%) patients became pain free (p = 0.008), and at one year follow up 60 (51.2%) patients remained pain free (p = 0.002) when compared with preoperative pain scores. Pain improvement was more in patients with ABPI of 0.3 or more. The limb salvage rate was 67.6%. Thirty-eight (32.4%) patients end up in amputations. There was no mortality in this series. Conclusions: LS has a role in the management of ischemic symptoms and limb salvage in patients not amenable to vascular reconstruction. Preoperative ABPI has prognostic value in postoperative outcome, with clinical improvement if it is more than 0.3. Smoking was a negative predictive factor in our series.

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