Does Chemical Lumbar Sympathectomy Have an Effective Role in Limb Salvage?

摘要

Scientific evidence to support the therapeutic role of chemical lumbar sympathectomy (CLS) in limb salvage remains poor. We studied patients with critical limb ischaemia (fountain grade III/IV) with no surgical or endovascular options between January 2001 and June 2005 using a prospective Computerised Vascular Audit System (CVAS) database. 95 (11 bilateral and 3 repeated) CLS in 81 patients were performed in our unit. At follow up (1- 36 months) 35% (28 of the 81) of patients post-sympathectomy had died without major (transtibial/ femoral) amputation (median survival 9 months), a further 20 underwent major amputations (median time to amputation post-sympathectomy 3.5 months) 10 of whom subsequently died. Thirty-three patients were still alive without major amputation. Overall, 75% of cases (61 of 81) avoided major amputation. We feel that CLS should continue to be considered in the clinical algorithm for limb salvage.