Effect of surgical lumbar sympathectomy on innervation of arterioles in the lower limb of patients with diabetes.

The innervation of lower limb epineurial arterioles, specimens of which were obtained from six patients in the sympathectomy and from six patients in the nonsympathectomy diabetic groups at amputation for ischemic peripheral vascular disease, was compared by quantitative ultrastructural methods. Results demonstrated no statistically significant difference in the number of vasomotor axons present, the average axon to smooth muscle cell distance or the axon distribution pattern in the adventitia between the two diabetic groups of patients. A previous investigation has established that innervation of these arterioles is significantly reduced in patients with diabetes having end-stage ischemia of the lower limb when compared with similar patients without diabetes. The present results demonstrate that surgical lumbar sympathectomy does not significantly further reduce the already severely diminished number of vasomotor nerves in some diabetic arterioles. This observation offers a possible explanation for the poorer success rate of those with diabetes compared with those without diabetes in avoiding amputation of the limb after lumbar sympathectomy.