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Value of Concomitant Sympathectomy in Aortoiliac Reconstruction: Results of a Prospective, Randomized Study

Value of Concomitant Sympathectomy in Aortoiliac Reconstruction: Results of a Prospective,... Abstract • The efficacy of concomitant lumbar sympathectomy in improving results of aortoiliac reconstruction was assessed by a prospective, randomized study of 51 patients undergoing operation for occlusive or aneurysmal disease. Sympathectomy was performed on 50 limbs, while 52 extremities served as controls. Sympathectomy resulted in a significant reduction in foot vascular resistance determined by plethysmography. However, the procedure had no effect on leg circulation, assessed by ankle/arm pressure indices determined by Doppler ultrasound. In the sympathectomy group, there were three early postoperative amputations for ischemia, despite patent grafts. In the control group, there was one late graft occlusion, caused by progressive atherosclerotic disease. Although sympathectomy may improve pedal circulation, the procedure does not appear to improve the results of aortoiliac reconstruction. (Arch Surg 112:1325-1330, 1977) References 1. Wylie EJ, Gardner R: Thromboendarterectomy, a clinical appraisal . Surgery 37:415, 1955. 2. DeBakey ME, Crawford ES, Cooley DA, et al: Surgical considerations of occlusive disease of the abdominal aorta and iliac and femoral arteries: Analysis of 803 cases . Surgery 148:306, 1958. 3. Cannon JR, Barker WF, Kawakami IG: Femoral popliteal endarterectomy in treatment of obliterative atherosclerotic disease . Surgery 43:76, 1958. 4. Ghiringhelli C, Demetz A: Considerations about the association of lumbar sympathectomy with arterial grafting, bypass operations and arterectomies of the lower limbs . Vase Surg 1:51, 1968. 5. Weismann RE, Upson JE: Use of lumbar sympathectomy as an adjunct to reconstructive arterial surgery . Ann Surg 154:788-790, 1961.Crossref 6. Szilagyi DE, Smith RF, Scerpella JR, et al: Lumbar sympathectomy: Current role in the treatment of arteriosclerotic occlusive disease . Arch Surg 95:753-760, 1967.Crossref 7. Strandness DE Jr: Long term value of lumbar sympathectomy . Geriatrics 21:144-155, 1966. 8. Sumner DS, Folse R: Persistent hyperemia following prolonged arterial occlusion . Ann Surg 168:837-843, 1968.Crossref 9. Fulton RL, Blakeley WR: Lumbar sympathectomy: A procedure of questionable value in the treatment of arteriosclerosis obliterans of the legs . Am J Surg 116:735, 1968.Crossref 10. Simeone FA, Husni EA: Hyperemia of reconstructive arterial surgery . Ann Surg 150:575-585, 1959.Crossref 11. Shanik GD, Ford J, Hayes AC, et al: Pedal vasomotor tone following aortofemoral reconstructions: A randomized study of concomitant lumbar sympathectomy . Ann Surg 183:136-138, 1976.Crossref 12. Shanik GD, Hayes A, Barnes RW: Foot vascular resistance index: Noninvasive method to assess foot vasomotor tone . Surgery 78:446-452, 1975. 13. Strandness DE Jr, Sumner DS: Hemodynamics for Surgeons . New York, Grune & Stratton Inc, 1975. 14. Shanik GD, Barnes RW, Fitzgerald P: Foot vasomotor tone following aortofemoral and femoropopliteal reconstruction for limb ischemia . J Cardiovasc Surg 18:129-136, 1977. 15. Gillespie JA: Future place of lumbar sympathectomy in obliterative vascular disease of lower limbs . Br Med J 1:1640-1642, 1960.Crossref 16. Lynn RB, Barcroft H: Circulatory changes in the foot after lumbar sympathectomy . Lancet 1:1105-1108, 1950.Crossref 17. Delaney J, Scarpino J: Limb arteriovenous shunting following sympathetic denervation . Surgery 73:202-206, 1973. 18. Rutherford RB, Valenta J: Extremity blood flow and distribution: The effects of arterial occlusion, sympathectomy and exercise . Surgery 69:332-344, 1971. 19. Moore WS, Hall AD: Effects of lumbar sympathectomy on skin capillary blood flow in arterial occlusive disease . J Surg Res 14:151-517, 1973.Crossref 20. Nielsen PE, Augustenborg G, Lassen NA: Reduction in distal blood pressure by sympathetic nerve block in patients with occlusive arterial disease . Scand J Clin Lab Invest 31:59-62, 1973. 21. Strandness DE Jr, Tolstedt GE, Bell JW: Results of combined surgical therapy in management of peripheral arterial disease . Arch Surg 81:151-156, 1960.Crossref 22. Mavor GE: Intermittent claudication and sympathectomy . Lancet 1:794-796, 1955.Crossref 23. Shepherd JT: The effect of acute occlusion of the femoral artery on the blood supply to the calf of the leg before and after release of sympathetic vasomotor tone . Clin Sci 9:355-365, 1950. 24. Dornhorst AD, Sharpey-Schafer EP: Collateral resistance in limbs with arterial obstruction: Spontaneous changes and effects of sympathectomy . Clin Sci 10:371-381, 1951. 25. Hoffman DC, Jepson RP: Muscle blood flow and sympathectomy . Surg Gynecol Obstet 127:12-16, 1968. 26. Wright CJ, Cousins MJ: Blood flow distribution in the human leg following epidural sympathetic blockade . Arch Surg 105:334-337, 1972.Crossref 27. Kountz SL, Cohn R: Aortic blood flow following lower aortic resection and sympathectomy . Surgery 55:173-176, 1965. 28. Weale FE: Hemodynamic assessment of the arterial tree during reconstructive surgery . Ann Surg 169:489-495, 1969.Crossref 29. Weissenhofer W, Schenk WG Jr: Effects of sympathectomy on blood flow through stenotic vessels during exercise: An experimental study in a canine model . Surgery 74:734-738, 1973. 30. May AG, DeWeese JA, Robb CG: Effect of sympathectomy on blood flow in arterial stenosis . Ann Surg 158:182-188, 1963.Crossref 31. Perrin M: Is lumbar sympathectomy liable to influence the results of reconstructive arterial surgery? J Cardiovasc Surg 16:381-385, 1975. 32. Stricht J VD: The influence of lumbar sympathectomy on the permeability of reconstructions . J Cardiovasc Surg 16:552-553, 1975. 33. Myers KA, Irveine WT: An objective study of lumbar sympathectomy: I. Intermittent claudication . Br Med J 1:879-883, 1966.Crossref 34. Strandness DE Jr, Bell JW: Peripheral vascular disease: Diagnosis and objective evaluation using a mercury strain gauge . Ann Surg 161:3-35, 1965. 35. Husni EA, Simeone FA: Results of lumbar sympathectomy in peripheral vascular disease: An evaluation of preoperative laboratory tests . Arch Surg 75:530-541, 1957.Crossref 36. Smithwick RH: Lumbar sympathectomy in the treatment of obliterative vascular disease of the lower extremities . Surgery 42:415-430, 1957. 37. Yao JST, Bergan JJ: Predictability of vascular reactivity relative to sympathetic ablation . Arch Surg 107:676-680, 1973.Crossref 38. Thulesius O, Gjores JE, Mandaus L: Distal blood flow and blood pressures in vascular occlusion: Influence of sympathetic nerves on collateral blood flow . Scand J Clin Lab Invest 31:53-57, 1973. 39. Gillespie JA: The late effects of lumbar sympathectomy on blood flow in the foot in the presence of occlusive arterial disease . Scand J Clin Lab Invest 99:219-221, 1972. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Value of Concomitant Sympathectomy in Aortoiliac Reconstruction: Results of a Prospective, Randomized Study

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1977.01370110059006
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Abstract

Abstract • The efficacy of concomitant lumbar sympathectomy in improving results of aortoiliac reconstruction was assessed by a prospective, randomized study of 51 patients undergoing operation for occlusive or aneurysmal disease. Sympathectomy was performed on 50 limbs, while 52 extremities served as controls. Sympathectomy resulted in a significant reduction in foot vascular resistance determined by plethysmography. However, the procedure had no effect on leg circulation, assessed by ankle/arm pressure indices determined by Doppler ultrasound. In the sympathectomy group, there were three early postoperative amputations for ischemia, despite patent grafts. In the control group, there was one late graft occlusion, caused by progressive atherosclerotic disease. Although sympathectomy may improve pedal circulation, the procedure does not appear to improve the results of aortoiliac reconstruction. (Arch Surg 112:1325-1330, 1977) References 1. Wylie EJ, Gardner R: Thromboendarterectomy, a clinical appraisal . Surgery 37:415, 1955. 2. DeBakey ME, Crawford ES, Cooley DA, et al: Surgical considerations of occlusive disease of the abdominal aorta and iliac and femoral arteries: Analysis of 803 cases . Surgery 148:306, 1958. 3. Cannon JR, Barker WF, Kawakami IG: Femoral popliteal endarterectomy in treatment of obliterative atherosclerotic disease . Surgery 43:76, 1958. 4. Ghiringhelli C, Demetz A: Considerations about the association of lumbar sympathectomy with arterial grafting, bypass operations and arterectomies of the lower limbs . Vase Surg 1:51, 1968. 5. Weismann RE, Upson JE: Use of lumbar sympathectomy as an adjunct to reconstructive arterial surgery . Ann Surg 154:788-790, 1961.Crossref 6. Szilagyi DE, Smith RF, Scerpella JR, et al: Lumbar sympathectomy: Current role in the treatment of arteriosclerotic occlusive disease . Arch Surg 95:753-760, 1967.Crossref 7. Strandness DE Jr: Long term value of lumbar sympathectomy . Geriatrics 21:144-155, 1966. 8. Sumner DS, Folse R: Persistent hyperemia following prolonged arterial occlusion . Ann Surg 168:837-843, 1968.Crossref 9. Fulton RL, Blakeley WR: Lumbar sympathectomy: A procedure of questionable value in the treatment of arteriosclerosis obliterans of the legs . Am J Surg 116:735, 1968.Crossref 10. Simeone FA, Husni EA: Hyperemia of reconstructive arterial surgery . Ann Surg 150:575-585, 1959.Crossref 11. Shanik GD, Ford J, Hayes AC, et al: Pedal vasomotor tone following aortofemoral reconstructions: A randomized study of concomitant lumbar sympathectomy . Ann Surg 183:136-138, 1976.Crossref 12. Shanik GD, Hayes A, Barnes RW: Foot vascular resistance index: Noninvasive method to assess foot vasomotor tone . Surgery 78:446-452, 1975. 13. Strandness DE Jr, Sumner DS: Hemodynamics for Surgeons . New York, Grune & Stratton Inc, 1975. 14. Shanik GD, Barnes RW, Fitzgerald P: Foot vasomotor tone following aortofemoral and femoropopliteal reconstruction for limb ischemia . J Cardiovasc Surg 18:129-136, 1977. 15. Gillespie JA: Future place of lumbar sympathectomy in obliterative vascular disease of lower limbs . Br Med J 1:1640-1642, 1960.Crossref 16. Lynn RB, Barcroft H: Circulatory changes in the foot after lumbar sympathectomy . Lancet 1:1105-1108, 1950.Crossref 17. Delaney J, Scarpino J: Limb arteriovenous shunting following sympathetic denervation . Surgery 73:202-206, 1973. 18. Rutherford RB, Valenta J: Extremity blood flow and distribution: The effects of arterial occlusion, sympathectomy and exercise . Surgery 69:332-344, 1971. 19. Moore WS, Hall AD: Effects of lumbar sympathectomy on skin capillary blood flow in arterial occlusive disease . J Surg Res 14:151-517, 1973.Crossref 20. Nielsen PE, Augustenborg G, Lassen NA: Reduction in distal blood pressure by sympathetic nerve block in patients with occlusive arterial disease . Scand J Clin Lab Invest 31:59-62, 1973. 21. Strandness DE Jr, Tolstedt GE, Bell JW: Results of combined surgical therapy in management of peripheral arterial disease . Arch Surg 81:151-156, 1960.Crossref 22. Mavor GE: Intermittent claudication and sympathectomy . Lancet 1:794-796, 1955.Crossref 23. Shepherd JT: The effect of acute occlusion of the femoral artery on the blood supply to the calf of the leg before and after release of sympathetic vasomotor tone . Clin Sci 9:355-365, 1950. 24. Dornhorst AD, Sharpey-Schafer EP: Collateral resistance in limbs with arterial obstruction: Spontaneous changes and effects of sympathectomy . Clin Sci 10:371-381, 1951. 25. Hoffman DC, Jepson RP: Muscle blood flow and sympathectomy . Surg Gynecol Obstet 127:12-16, 1968. 26. Wright CJ, Cousins MJ: Blood flow distribution in the human leg following epidural sympathetic blockade . Arch Surg 105:334-337, 1972.Crossref 27. Kountz SL, Cohn R: Aortic blood flow following lower aortic resection and sympathectomy . Surgery 55:173-176, 1965. 28. Weale FE: Hemodynamic assessment of the arterial tree during reconstructive surgery . Ann Surg 169:489-495, 1969.Crossref 29. Weissenhofer W, Schenk WG Jr: Effects of sympathectomy on blood flow through stenotic vessels during exercise: An experimental study in a canine model . Surgery 74:734-738, 1973. 30. May AG, DeWeese JA, Robb CG: Effect of sympathectomy on blood flow in arterial stenosis . Ann Surg 158:182-188, 1963.Crossref 31. Perrin M: Is lumbar sympathectomy liable to influence the results of reconstructive arterial surgery? J Cardiovasc Surg 16:381-385, 1975. 32. Stricht J VD: The influence of lumbar sympathectomy on the permeability of reconstructions . J Cardiovasc Surg 16:552-553, 1975. 33. Myers KA, Irveine WT: An objective study of lumbar sympathectomy: I. Intermittent claudication . Br Med J 1:879-883, 1966.Crossref 34. Strandness DE Jr, Bell JW: Peripheral vascular disease: Diagnosis and objective evaluation using a mercury strain gauge . Ann Surg 161:3-35, 1965. 35. Husni EA, Simeone FA: Results of lumbar sympathectomy in peripheral vascular disease: An evaluation of preoperative laboratory tests . Arch Surg 75:530-541, 1957.Crossref 36. Smithwick RH: Lumbar sympathectomy in the treatment of obliterative vascular disease of the lower extremities . Surgery 42:415-430, 1957. 37. Yao JST, Bergan JJ: Predictability of vascular reactivity relative to sympathetic ablation . Arch Surg 107:676-680, 1973.Crossref 38. Thulesius O, Gjores JE, Mandaus L: Distal blood flow and blood pressures in vascular occlusion: Influence of sympathetic nerves on collateral blood flow . Scand J Clin Lab Invest 31:53-57, 1973. 39. Gillespie JA: The late effects of lumbar sympathectomy on blood flow in the foot in the presence of occlusive arterial disease . Scand J Clin Lab Invest 99:219-221, 1972.

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1977

References