Lumbar sympathectomy for severe lower limb ischaemia: results and analysis of factors influencing the outcome.

Sixty consecutive patients (66 legs) underwent surgical lumbar sympathectomy as the only therapy for severe lower limb ischaemia (pain at rest and/or frank gangrene) caused by arteriosclerosis in the period 1977 to 1982. After six months results were good, as defined by absence of pain at rest, healing of ischaemic lesions and no major amputation, in 48% of limbs and bad in all other limbs. Patients with rest pain only fared much better than those with gangrene: after six months a major amputation had to be performed in 14% and 45% respectively. The presence or absence of diabetes mellitus and palpable pulsations at knee level and the angiographic patterns were of no help in the prediction of the results of lumbar sympathectomy. Doppler ankle/arm indices did have predictive value, since in all limbs with Doppler indices lower than 0.30 a major amputation had to be performed. Lumbar sympathectomy still remains a useful procedure in the treatment of selected patients with severe lower limb ischaemia in which reconstructive surgery is not feasible. But it is only advocated in the presence of ankle/arm indices above 0.30 and in the absence of gangrenous lesions.