Lumbar sympathectomy for lower extremity vasospasm.

Ten patients, 8 female and 2 male, with refractory episodic lower extremity vasospasm were encountered during a 15 year period in which over 600 patients with upper extremity vasospasm were studied. Seven patients had associated upper extremity vasospasm. No patient had evidence of autoimmune disease. Lower extremity reserpine Bier block produced symptomatic relief for 1 to 3 days in all patients in whom it was used. Oral medications were ineffectual. A diagnostic toe photoplethysmographic pattern was noted in these patients, consisting of a normally pulsatile tracing after warming and a flat, nonpulsatile or minimally pulsatile tracing after cooling. Each patient underwent lumbar sympathectomy. During follow-up, which averaged 4 years, each patient remained free of episodic vasospasm on the side of surgery. We conclude that lumbar sympathectomy is an effective and durable treatment for lower extremity vasospasm.