Since the advent of reconstructive arterial surgery, the place of lumbar sympathectomy in the management of occlusive arterial disease has been undergoing a continuous reappraisal, as shown by several recent reports.1-6
While the superiority of results achieved with grafting procedures and endarterectomy, especially in aortoiliac disease is well established, their use in the femoropopliteal segment is greatly limited either by advanced lesions or disappointing long-term followups.
In these cases the only available surgical method of revascularization is lumbar sympathectomy. It is obviously a second best since its objective is more limited than that of direct arterial surgery, as it promotes only development of collateral circulation. Despite these limitations, lumbar sympathectomy has definite indications in the management of peripheral occlusive arterial disease.
Indeed, in an extremity with the main arteries occluded, its viability will depend entirely upon the blood supply through the available collaterals. While in a number of cases
HAIMOVICI H, STEINMAN C, KARSON IH. Evaluation of Lumbar Sympathectomy: Advanced Occlusive Arterial Disease. Arch Surg. 1964;89(6):1089–1095. doi:10.1001/archsurg.1964.01320060157028
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