Chemical lumbar sympathectomy (ChLS) in treatment of the lower limbs’ ischaemia – 15 years experience
Journal Title: Postępy Nauk Medycznych - Year 2011, Vol 24, Issue 6
Abstract
The results critical limb ischaemia with the chemical or classical lumbar symphatectomy remain controversial. Nevertheless those procedures are still performed.The aim of the study was present 15 years of personal experience with the treatment of chronic limb ischaemia using chemical lumbar sympathectomy.Material and methods. 626 procedures were performed in the Department of Vascular Surgery and Angiology during the period from 1.10. 1995 until 3109.2010. The age of patients ranged form 22 yrs up to 91 (mean of 68 yrs). There were448 men and 160 women (some of them had bilateral symphatectomy – 18 patients). The main indications for the procedure were: atherosclerosis, thromboangiitis of the vessels, diabetic foot, critical limb ischaemia prior to elective revascularisation procedure, refidgeration. The procedure was routinely performed by puncture of lumbar region under the radiology control and then neurolysis of lumbar trunks was performed at the level of L1-L2. Few minor complications were observed: insignificant haematoma of perivertebral region – 4 pts, minor puncutre site pains, resolving within few days – 19 pts, transient pains and paresthesias of femoral region of the skin – 28 pts. The time of procedure was short, with no stress.Results. The time of observation was 3 months to 9.5 years. A direct, postive result remaining for at least 3 months was observed among 70% of patients, lasting up to 6 months – among 55% of patients and alsting up to 1 year among 43% of patients. The best and longest positive effects following chemical symphatectomy were seen among patients with thromboangiitis, refidgeration, worse among patients with atherosclerosis and bad among patients with diabetes. During the period of 1 year following chemical sympathectomy – „major” amputations were performed among 20% of patients and within 2 years among 35%. There were no differences between classical and chemical symphatectomy regarding the results.Conclusions. Chemical symphatectomy is a simple minimallly invasive procedure, enabling to obtain clinical improvement among significant number of patients. Taking into account its advantages and comparable results to classic and laparoscopic procedures – chemcal symphatectomy should be performed more frequently.
Authors and Affiliations
Witold Raciborski, Walerian Staszkiewicz, Grzegorz Madycki
Keywords
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