Evaluation of effectiveness of lumbar sympathectomy by non invasive diagnostic techniques.

Out of a total of more than 1,200 patients in whom lumbar sympathectomy was carried out, two groups of 96 and 50 consecutive and non selected patients were evaluated before and after the operation by non invasive physiologic tests (digital plethysmography, post-occlusive reactive hyperemia, segmental blood pressure at rest and after exercise, Strandness test). Results were compared with angiography and clinical data. The statistical study of results corroborates the following points. 1. Lumbar sympathectomy is essentially effective in atherosclerotic arterial disease, but much less so in diabetic patients and in cases of widespread disease. 2. Patients with obstructive disease of the femoral artery had more improvement (t = 4.25) than patients with obstruction of peripheral arteries (t = 2.4). 3. Walking time was significantly improved after sympathectomy (p = 0.02). 4. Only one parameter, rheographic quotient Rq was statistically improved (p = 0.01). 5. The post occlusive reactive hyperemia test is a good method to predict the results of lumbar sympathectomy (correlation r = 0.22). We feel that this operation is indicated in cases of: isolated obstruction of the femoral artery with claudication superior to 200 meters, reconstruction with an associated obstruction of the superficial femoral artery.