Clinical results of lumbar sympathectomy alone or as a complement of direct arterial surgery.

Six hundred and eighty patients underwent conservative surgery for chronic obliterative arterial disease of the lower limbs during a 15 year period ranging from 1960 to 1974. Two hundred and fifty-three lumbar sympathectomy were performed in 240 patients, 339 patients had direct surgery and in 133 cases lumbar sympathectomy was added to direct surgery. From this experience the authors conclude: 1. Lumbar sympathectomy has a low mortality rate (3 deaths or 1.18%) and no important after effects: in particular no sexual problems are reported. 2. Lumbar sympathectomy for intermittent claudication seems to be useful since it apparently improves symptoms and prognosis of the operated leg. 3. Lumbar sympathectomy for rest pains or necrosis can be useful in 1/3 of the patients with proximal arterial lesions and in 2/3 of the patients with only peripheral lesions. 4. Lumbar sympathectomy should always be added to direct arterial surgery above the inguinal ligament since it improves the patency rate of arterial reconstruction without increasing the operative risk.