Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029.
Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
AJR Am J Roentgenol. 2021 May;216(5):1273-1282. doi: 10.2214/AJR.20.23089. Epub 2021 Mar 3.
The purpose of this study was to assess the effects of anatomic and technical factors on the long-term outcome of CT-guided lumbar sympathectomy in patients with chronic limb-threatening ischemia. Thirty patients (28 men, two women; mean age, 45.8 years) with chronic limb-threatening ischemia and diffuse tibial arterial disease not amenable to revascularization were included. CT-guided lumbar sympathectomy was performed at the L2-L3 level with a 22-gauge Chiba needle and absolute alcohol. Any periprocedural complication was noted. Numeric pain score (1-10 scale) and skin ulcers were assessed before the procedure and 3 weeks, 3 months, and 1 and 2 years after the procedure. According to spread of alcohol, patients were categorized into those with medial spread and those without medial spread (lateral spread group) with the lateral edge of the vertebral body as the reference point. Treatment results were categorized as improved, unchanged, or worsened on the basis of clinical response. There were 22 (73.3%) patients in the medial spread group and eight (26.7%) in the lateral spread group. The mean volumes of alcohol injected per side were not significantly different ( = .50). One major complication occurred in the group with medial spread. Mean numeric pain scores before the procedure and 3 weeks, 3 months, and 1 and 2 years afterward were 7.31, 2.95, 2.47, 2.10, and 2.04 in the medial spread group and 6.25, 4.13, 4.50, 4.35 and 4.32 in the lateral spread group ( < .001). At 2 years, 16 patients in the medial spread group and two patients in the lateral spread group showed clinical improvement ( < .001), and the limb salvage rates were 100% and 87.5%, respectively. Multivariate analysis showed a trend in improvement with smoking cessation, but the difference was not statistically significant ( = .15). The direction of spread of the neurolytic agent, however, was a major determinant of outcome. CT-guided lumbar sympathectomy is a simple, safe, and effective procedure. Ensuring medial spread of the neurolytic agent significantly improves long-term results.
本研究旨在评估解剖和技术因素对 CT 引导下腰椎交感神经切除术治疗慢性肢体威胁性缺血患者长期疗效的影响。 纳入 30 例（28 名男性，2 名女性；平均年龄 45.8 岁）慢性肢体威胁性缺血伴弥漫性胫骨动脉疾病且不适宜血管重建的患者。采用 22 号 Chiba 针和无水酒精在 L2-L3 水平行 CT 引导下腰椎交感神经切除术。记录任何围手术期并发症。采用数字疼痛评分（1-10 分）和皮肤溃疡评估术前、术后 3 周、3 个月、1 年和 2 年的情况。根据酒精扩散情况，以椎体侧缘为参照点，将患者分为内侧扩散组和无内侧扩散（外侧扩散组）。根据临床反应将治疗结果分为改善、不变或恶化。内侧扩散组 22 例（73.3%），外侧扩散组 8 例（26.7%）。双侧酒精注射量无显著差异（ =.50）。内侧扩散组发生 1 例严重并发症。内侧扩散组术前及术后 3 周、3 个月、1 年和 2 年的平均数字疼痛评分分别为 7.31、2.95、2.47、2.10 和 2.04，外侧扩散组分别为 6.25、4.13、4.50、4.35 和 4.32（ <.001）。2 年后，内侧扩散组 16 例和外侧扩散组 2 例患者临床改善（ <.001），肢体存活率分别为 100%和 87.5%。多因素分析显示，戒烟与改善呈趋势相关，但差异无统计学意义（ =.15）。然而，神经溶解剂扩散方向是决定疗效的主要因素。 CT 引导下腰椎交感神经切除术是一种简单、安全、有效的方法。确保神经溶解剂的内侧扩散可显著改善长期疗效。
