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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2004 June;163(3):71-4
Does lumbar sympathectomy still have a place between therapeutic options of peripheral arterial diseases?
Cardia G. 1, Lippolis A. 2, Centonze A. 2, Topi S. 1
1 U.O. Semplice Chirurgia Vascolare, Ospedale Policlinico, Bari;
2 Chirurgia Generale III, Università degli Studi di Bari, Bari
Aim. In 1925 Adson et al. first introduced lumbar sympathectomy (LS) for peripheral arterial obstructive disease (PAOD). Only patients in stage III and IV of Fontaine’s classification are successfully treated, while diabetics and those with proximal (iliac) lesions don’t have substantial benefit. The aim of this paper is to verify the incidence of this form of treatment in the last years, and 2 distinct periods are analyzed.
Methods. During 1993/1996, a total of 150 surgical arterial procedures on lower limbs were performed, 59 of which were LS (34%). In 1997/1999 LS were 10 on a total of 88 operations (9.8%).
Results. The fall in the incidence of LS in our patients may be explained on the basis of 2 main data: 1) the utilization of a higher number of pharmacological sympathicolysis in old patients; 2) the addition of prostanoids in therapeutical protocols. Especially with these last drugs in many patients a clear improvement and the cicatrization of necrotic areas were obtained.
Conclusion. Therefore, it is possible to confirm that LS still represents a second choice procedure in those cases with contraindication to a direct revascularization, in spite of the good results obtained by medical therapy.