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PubMed2001

The effect of lumbar sympathectomy on increased tactile sensitivity in spinal nerve ligated rats.

The aim of this study was to investigate the reason for the contradictory results following surgical sympathectomy on increased tactile sensitivity in spinal nerve ligated rats. For this purpose, firstly the results of L5 spinal nerve ligation alone and both L5 and L6 (L5/6) spinal nerve ligation were compared in Sprague-Dawley rats. Secondly, the difference in tactile sensitivity between the plantar surface (the middle glabrous area on the foot pads of the hind paw) and on the toe (the proximal half of the third and fourth toe of the hind paw) after the spinal nerve injury was studied. Third, we divided the L5 spinal nerve ligated rats into two groups, (i.e. low and high threshold groups) based on the degree of tactile sensitivity and investigated the effect of surgical lumbar sympathectomy (L2-L5) on tactile sensitivity in both the plantar and toe areas. The results show that the tactile sensitivities of L5 spinal nerve ligated rats and L5/6 spinal nerve ligated rats were not different. However, tactile sensitivities of the plantar surface were less than those of toe area suggesting that the response from toe is a better indicator of neuropathic pain. Surgical sympathectomy reduced the response from only the toe area and only in the low threshold group. These results suggest that the reason for the contradictory results of surgical sympathectomy in spinal nerve ligation models is, at least in part, the difference in the degree of mechanical allodynia in each study.

Animals↗
PubMed1997

Effects of deferoxamine and sympathectomy on endothelin-1-induced contraction and acetylcholine-induced relaxation following subarachnoid hemorrhage in carotid artery.

The role of endothelium-related factors in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage (SAH) has gained interest since the discovery of EDRF and of endothelin-1 (ET-1). The effect of SAH and both treatment of deferoxamine (DFO) and sympathectomy on endothelium-dependent vasodilation and ET-1-induced vasoconstriction of isolated rabbit carotid artery was examined using an isometric tension recording method. Thirty-five rabbits were divided into four groups: control animals, 7 days after SAH, treatment with DFO after SAH for 7 days and sympathectomy after SAH. Acetylcholine (10(-8) to 10(-5) M) was used to evoke concentration-dependent vasodilation of isolated arterial rings previously contracted by 10(-6) M phenylephrine. In the animals killed 7 days after SAH, acetylcholine-induced relaxation was suppressed and the degree of relaxation of this group was 50% of the initial contractile tone in response to the 10(-5) M acetylcholine. These relaxant responses did not return to control values in carotid arteries obtained from animals treated with DFO and subjected to sympathectomy. In isolated carotid arteries, ET-1 (10(-10) to 10(-8) M) produced concentration-dependent contractions. These contractile responses were significantly enhanced in animals 7 days after SAH compared with controls and did not return to control values in carotid arteries obtained from animals both treated with DFO and sympathectomized for 7 days after SAH. The present experiments suggest that impairment of endothelium-dependent vasodilation and the hyperreactivity of ET-1 of the carotid artery as well as cerebral arteries may be involved in the pathogenesis of cerebral vasospasm. Both treatment with DFO and sympathectomy during the chronic stage for vasospasm after SAH did not affect these vascular responses of the extradural part of the carotid artery to ET-1 and acetylcholine.

Acetylcholine↗
PubMed1995

The microcirculatory effects of peripheral sympathectomy.

Microvascular physiology following peripheral artery sympathectomy was evaluated in seven hands with refractory pain (n = 7) and ulceration (n = 7) by serial isolated cold stress testing, which measures digital temperature and cutaneous perfusion (laser Doppler fluxmetry). All patients (n = 6) had vasospasm (secondary Raynaud's phenomenon) and arteriographically proven digital and palmar occlusive disease. Microcirculatory flow responses were correlated with symptoms and signs (including ulcer healing) before and after (2-8 weeks, 12-15 weeks, and 24 weeks) peripheral sympathectomy. Baseline data were compared with those of controls (n = 7 extremities). Following surgery, all seven hands had diminished pain; six had ulcer healing and one had ulcer reduction. Isolated cold stress testing demonstrated abnormalities in temperature and laser Doppler fluxmetry response between patients and controls. Although total flow (reflected by temperature) was not significantly increased after surgery, peripheral sympathectomy increased nutritional flow in these patients with combined vasospastic vessels and occlusive injury. The clinical changes observed following peripheral sympathectomy appear to be related to postsurgical correction of abnormal arteriovenous shunting and to improved nutritional blood flow to ischemic areas. This accounts for the resultant diminution of pain and healing of ulcers observed in these patients after surgery.

Adult↗
PubMed2002

Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach.

OBJECTIVES: This is a prospective study to evaluate the long-term outcome and the value of a transaxillary single port thoracic sympathectomy by use of a modified paediatric cystoresectoscope in a consecutive series of patients with facial blushing and/or hyperhidrosis. MATERIALS AND METHODS: All patients who underwent a thoracic transsection of the sympathetic chain from T2 to T5 by use of a 7-mm single port approach and a modified urologic electroresectoscope between 1996 and 1998 were prospectively analysed regarding postoperative morbidity and outcome (clinical evaluation, visual analogue scale) in order to validate this technique. RESULTS: 37 patients (18 men, 19 women) with an age ranging from 18 to 67 years (mean 34 years) underwent 74 bilateral video-assisted thoracic sympathectomies. The indications for sympathectomy included facial blushing in 32%, hyperhidrosis in 52%, or both in 16% of the patients. Ninety-five percent of the patients were discharged from the hospital on the next day, the 30-day mortality was zero, and there was no conversion to an open procedure. A severe complication with crossed emboli and motor aphasia was noted. A unilateral transient Horner's syndrome was observed in two patients. Three-month follow-up revealed an excellent cosmetic and functional result, with no residual pain. Complete relief of symptoms was observed in 89% and in 100% of the patients with facial blushing and palmar hyperhidrosis, respectively, after a follow-up of 34.5 months. Recurrence of the symptoms after initial regression was noted in 5.7% of the patients 3 years after surgery. Compensatory sweating of the lower extremities was significantly increased in patients with hyperhidrosis and facial blushing; however, sweating of the trunk was only increased in patients with hyperhidrosis. Improvement of quality of life was observed in 94.6% of the patients. CONCLUSIONS: Single port thoracoscopic sympathectomy by use of a modified paediatric cystoresectoscope and transsection from T2 to T5 gives an excellent cosmetic and functional outcome, with better results in patients with hyperhidrosis.

Adolescent↗
PubMed1996

Endoscopic versus transaxillary thoracic sympathectomy for primary axillary and palmar hyperhidrosis and/or facial blushing: 5-year-experience.

Thoracic sympathectomy is effective in the permanent cure of primary axillary and palmar hyperhidrosis and facial blushing, which can be so troublesome for patients that their social and professional relations can be affected. Between October 1988 and April 1994, a total of 50 thoracic sympathectomies (10 surgical and 40 endoscopic) were performed on 5 and 23 patients, respectively. The operations were performed unilaterally, followed by the contralateral intervention after a period of 6-8 weeks. The thoracic ganglia T2-T5 were resected for hyperhidrosis. If the patient suffered from blushing, the lower 1/3 of the stellate ganglion was also resected. Postoperatively, all the operated limbs were warm and dry. In the group of patients who were operated bilaterally, only one had persistent facial blushing. The efficacy for blushing in this series was therefore 93.3%. The late relapse rate of sympathetic activity was 14.3%. Compensatory sweating was seen in 67%, gustatory sweating in 37.5% and phantom sweating in 29% of the patients. None of them considered these side effects to be troublesome. Although there is no difference between transaxillary thoracic sympathectomy and the endoscopic intervention in terms of efficacy, the latter is associated with less postoperative pain, shorter hospital stay and a rapid recovery. The thoracic sympathectomy is the treatment of choice for primary hyperhidrosis and excessive facial blushing.

Adult↗
PubMedDate not supplied

Continuous regional anesthesia before surgical peripheral sympathectomy in a patient with severe digital necrosis associated with Raynaud's phenomenon and scleroderma.

BACKGROUND AND OBJECTIVE: Digital ischemia and necrosis caused by Raynaud's phenomenon in patients with connective tissue diseases may not respond to medical therapy and may have major adverse effects on quality of life. We describe the use of continuous ambulatory regional anesthesia for diagnosis and treatment before peripheral sympathectomy in a patient with secondary Raynaud's phenomenon. CASE REPORT: A 55-year-old man with progressive systemic sclerosis and secondary Raynaud's phenomenon presented with severe pain and digital necrosis that were refractory to maximal medical treatment and thoracic sympathectomy. Continuous ambulatory regional analgesia increased digital temperature from 32.3 degrees C at baseline to 34.4 degrees C after 80 minutes. An increase in digital flow was documented by Doppler ultrasound measurements made ventrally at the point of greatest pulsation of the radial artery. Subsequent peripheral sympathectomy resulted in restoration of nutrient flow with healing of ulcers and alleviation of pain. CONCLUSIONS: Continuous ambulatory regional anesthesia appears effective as a treatment bridge for vasospasm and ischemia associated with secondary Raynaud's phenomenon. The enhancement of peripheral blood flow achieved with the regional anesthetic technique suggests that surgical peripheral sympathectomy may provide long-term benefits.

Anesthesia, Conduction↗
PubMed2004

[Thoracoscopic sympathectomy for palmar hyperhidrosis. Immediate results and postoperative quality of life].

OBJECTIVE: Primary palmar hyperhidrosis is a socially and occupationally debilitating disorder characterized by excessive sweating. The purpose of this study was to evaluate the results, complications, and degree of satisfaction among patients who underwent video-assisted bilateral thoracoscopic sympathectomy of the second and third ganglia (T2-T3) to treat primary palmar hyperhidrosis at the Department of General and Thoracic Surgery of the Hospital Universitario Virgen Macarena in Seville, Spain. MATERIAL AND METHOD: A study of 226 thoracoscopic sympathectomies was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample was composed of 113 patients (47 males and 66 females), ranging in age from 14 to 50 years, with primary palmar and axillary hyperhidrosis, in some cases severe. Bilateral video-assisted thoracoscopic T2-T3 sympathectomy was performed under general anesthesia in all cases. Follow up included a questionnaire on pre- and postoperative quality of life and degree of satisfaction. Descriptive statistics on the surgical procedure, quality of life, and postoperative changes were compiled and frequency analyzed. A nonparametric Wilcoxon test for paired variables was performed to contrast significant differences between pre- and postoperative quality of life related to hyperhidrosis and its complications. RESULTS: The therapeutic success rate was 100%. Complications were seen in 14.2% of the cases and included hemothorax in two, hemopneumothorax in three, pleural hemorrhage in two, and minimal apical airspace in nine. Of the 106 patients who were monitored over a period of 6 to 12 months through follow-up interviews and questionnaires, 67% developed compensatory sweating, 95% reported improvement in quality of life, and 4% experienced no change in quality of life, mainly because of the emergence of compensatory sweating. Of the patients interviewed, 97.2% said that they would undergo the operation again. CONCLUSION: Video-assisted thoracoscopic sympathectomy for the treatment of primary palmar hyperhidrosis is effective, with low rates of morbidity and no mortality. Despite the appearance of postoperative changes such as compensatory sweating, patient satisfaction with the procedure is high and their quality of life improves.

Adolescent↗
PubMed1999

Chemical sympathectomy impairs bone resorption in rats: a role for the sympathetic system on bone metabolism.

The possibility that the nervous system may control bone metabolism has been raised, as neuromediators physiologically conveyed by sympathetic fibers (eg, vasoactive intestinal peptide) influence bone resorption in vitro. In this study, the sympathetic system was inactivated by treating rats with guanethidine (40 mg/kg/day), a sympathetic neurotoxic, for 21 days, after which a wave of osteoclastic resorption was induced along the mandibular buccal cortex. The effects of denervation were assessed 4 days later (corresponding to the peak of resorption in this model). The rats exhibited ptosis soon after starting guanethidine, proving the success of the sympathectomy. This was associated with a significant increase in calcitonin gene-related peptide- (+54%, p < 0.02) and substance P-immunoreactive sensory fibers (+29%,p < 0.02), a known effect of sympathectomy. For the quantitation of the bone parameters, the study zone was divided into a juxta-osseous alkaline phosphatase-positive osteogenic compartment and a nonosteogenic compartment. In the osteogenic compartment, the resorption surface was reduced by 56% (p < 0.001) in the treated animals, together with a fall in the number of osteoclasts (-25%,p < 0.05) and impaired osteoclast access to the bone surface. Tartrate-resistant acid phosphatase-positive (TRAP+) mononuclear preosteoclasts were found only in this compartment; they were reduced by 43% (p < 0.05) by the sympathectomy. No change in non-specific esterase (NSE)+ osteoclast precursors was found. In the nonosteogenic compartment, vasodilation was the only effect of sympathectomy (+80%,p < 0.05); in particular, the number of NSE+ cells was not modified. Our results indicate that: (1) interactions of NSE+ precursors with osteogenic cells are required for their differentiation into TRAP+ preosteoclasts; (2) the sympathetic nervous system is not involved in osteoclast precursor recruitment; but (3) has a significant effect on resorption by inhibiting preosteoclast differentiation and disturbing osteoclast activation. These data suggest that depletion of sympathetic mediators may disturb osteogenic cell-mediated osteoclast differentiation.

Alkaline Phosphatase↗
PubMed1999

Endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: intermediate term results.

BACKGROUND: The authors' experience of the efficacy and safety of endoscopic thoracic sympathectomy in the treatment of primary palmer hyperhidrosis was examined. METHODS: A retrospective study of 71 patients (126 sympathectomies) was undertaken. Data were retrieved by hospital records and telephone interview. RESULTS: Follow-up was possible for 92 sympathectomies in 53 patients. Overall, satisfactory results were achieved in 93% of patients and complications were uncommon. Compensatory hyperhidrosis was the most common complication, which occurred in 64% of patients; the trunk and feet were the most common sites. Horner's syndrome occurred in five patients, although in two it was a permanent complication. No patient expressed dissatisfaction with the procedure as a consequence of this complication. Pneumothorax occurred in 17.5% of cases, although the vast majority were incidental findings on a postoperative chest X-ray, and none required drainage. With the newer techniques of access, patient dissatisfaction with the cosmetic appearance has fallen from 27.3 to 6.4%. Overall 90% of patients said they would have the operation again, which represents a high level of patient satisfaction. CONCLUSIONS: Endoscopic thoracic sympathectomy is a safe and effective technique for primary palmer hyperhidrosis. Evolution of the technique has resulted in improvement in patient satisfaction.

Adolescent↗
PubMed2001

Bradycardia and permanent pacing after bilateral thoracoscopic T2-sympathectomy for primary hyperhidrosis.

A 23-year-old woman with craniofacial hyperhidrosis underwent bilateral thoracoscopic T2-sympathectomy. Marked sinus bradycardia with a mean heart rate of 49 beats/min by Holter ECG monitoring occurred after the procedure and persisted for > 2 years. Normal sinus node function was found by an invasive electrophysiological study and unopposed vagotonia after sympathectomy was diagnosed. A permanent pacemaker was implanted. Although reduced heart rate is a common phenomenon after bilateral dorsal sympathectomy, intractable bradycardia with permanent pacing is rare. This patient demonstrates one of the potential cardiac complications of bilateral sympathectomy.

Adult↗
PubMed1985

Ovarian sympathectomy in the golden hamster: effects on estrous cyclicity and follicular development.

The role of adrenergic nerves in estrous cyclicity and follicular growth was studied in sympathectomized hamster ovaries. Specific ovarian sympathectomy was accomplished by injection of 6-hydroxydopamine (6-OHDA) into the ovarian bursal sac. Ovarian sympathectomy abolished all fluorescent adrenergic nerves 4, 8 or 12 days after treatment. Bilateral ovarian sympathectomy on metestrus altered the first estrous cycle in 53% of the animals and 20% had an altered second cycle. All sham injected animals had normal cycles. Four days after sympathectomy, there was a decrease in healthy follicles 80-240 microns and 250-340 microns in diameter and increased atresia of follicles 80-240 microns and 350-440 microns in diameter compared to solvent treated ovaries. Bilateral 6-OHDA treatment did not affect ovarian weight, number of corpora lutea or the total number of follicles per ovary. These observations suggest that ovarian adrenergic nerves modulate healthy follicular development in the golden hamster.

Animals↗
PubMed2000

Histopathological examination of chemo-sympathectomy in cats.

In recent decades, there has been an increase in both the number of sympathectomy techniques, as well as the surgical findings of sympathetic anatomy. Currently the advanced technique of C-arm guided percutaneous thoracic chemo-sympathectomy is widely used for the treatment of palmar hyperhidrosis. However, a better understanding of chemical agents in sympathectomy is required. In this study, chemo-sympathectomy was performed in cats, using alcohol, glycerol and various concentrations of phenol, to determine the chronic neurotoxic effects of these chemical agents on the stellate ganglia. The stellate ganglia of 24 cats were exposed under endotracheal general anesthesia, then injected with about 0.02 ml of absolute alcohol, glycerol and phenol (10%, 25%, 50%, and 75% concentration) solutions, respectively. The stellate ganglia were taken for histological examination three weeks after the chemical injection. The results showed that the degenerative changes in the cytoplasm and nucleus of ganglionic cells and intercellular tissue were moderate and relatively moderate after the injection of alcohol and glycerol, respectively. Meanwhile, the stellate ganglia revealed mild, relatively moderate, serious and extremely serious degeneration after injection of 10%, 25%, 50%, and 75% phenol, respectively. In conclusion, we recommend a high concentration of phenol, in the least volume, as a chemical agent for clinical injection in the upper thoracic sympathetic ganglion.

Animals↗
PubMed1999

Properties of endothelium and smooth muscle cells in canine femoral arteries after lumbar sympathectomy.

OBJECTIVE: To find out whether the lumbar sympathectomy modulated the endothelial function (as measured by nitric oxide (NO) and prostacyclin (PGI2), and blood flow in the canine femoral artery. DESIGN: Laboratory experiments. SETTING: Teaching hospital, Japan. ANIMALS: 16 mongrel dogs. INTERVENTION: Unilateral sympathectomy from L3 to L6. MAIN OUTCOME MEASURES: Five weeks later, the changes in blood flow, the endothelium-dependent responses and the PGI2 production in the canine femoral arteries were measured. RESULTS: The median (range) blood flow of left (denervated) and right (innervated) femoral arteries was 162 ml/min (122-330) and 65 ml/min (40-92), respectively. There was a significant difference between the two groups (p < 0.01). The endothelium-dependent relaxations to acetylcholine, adenosine diphosphate (ADP) and A23187 were comparable. The amounts of PGI2 produced in the two groups were similar. Direct relaxation in response to sodium nitroprusside was also similar in the two groups. CONCLUSIONS: Lumbar sympathectomy did not alter the endothelial function, although the median blood flow in the denervated femoral arteries was significantly higher than in the innervated ones. The continuous vasodilatation after sympathectomy may be a more potent factor in the regulation of vascular tonus than the physiological regulation of NO and PGI2.

Animals↗
PubMed1999

Transthoracic endoscopic sympathectomy for palmar hyperhidrosis in children and adolescents: analysis of 350 cases.

Primary palmar hyperhidrosis (PH) often commences in childhood and adolescence and can be a disabling condition. There are few reports regarding endoscopic sympathectomy for PH in children and adolescents. Therefore, I present our experience with transthoracic endoscopic sympathectomy (TES) in treating PH in children and adolescents. From July 1994 to March 1998, a total of 350 patients underwent TES. There were 93 males and 257 females with a mean age of 12.9 years (range 5-17 years). All patients were placed in a half-sitting position under single-lumen intubated anesthesia. We performed ablation of the T2 ganglion using either a 6- or an 8-mm 0 degree thoracoscope (Karl Storz Company, Germany) via one 0.8-cm incision just below each axilla. Among these 350 patients, 699 sympathectomies were performed. Usually, TES was accomplished within 15 minutes (range 7-20 minutes). The surgical complications were minimal: one pneumothorax and one segmental lung collapse. There were no surgical deaths. With a mean postoperative follow-up period of 25 months (range 5-44 months), the result of TES was highly satisfactory in 331 patients (94.6%), although 301 patients (86%) developed compensatory sweating of the trunk and lower limbs, the distribution being the axillae (12%), back (86%), abdomen (48%), or lower limbs (78%). The recurrence rates of palmar hyperhidrosis were 0.6% in the first year, 1.1% in the second year, and 1.7% in the third year. Transthoracic endoscopic sympathectomy is a safe and effective method for treating PH in children and adolescents.

Adolescent↗
PubMed1992

Extended thoracoscopic T2-sympathectomy in treatment of hyperhidrosis: experience with 130 consecutive cases.

A new method of thoracoscopic T2-sympathectomy mentioned in a previous report was used on 36 cases of hyperhidrosis at Tainan Municipal Hospital in Taiwan between October 1, 1989 and July 31, 1990. To reduce the possibility of incomplete resection of sympathetic nerve tracts, including ganglions and their regeneration, the method was modified on August 1, 1990. Thereafter, routine total removal of T2 and T3 sympathetic ganglions, as well as wide lateral incisions of the pleura on the second, third, and fourth rib beds were performed for treatment of hyperhidrosis. This newly modified method, "extended thoracoscopic T2-sympathectomy," can be performed easily by thoracoscopic approach in the treatment of hyperhidrosis palmaris. From August 1, 1990 to May 31, 1991, 130 consecutive cases of hyperhidrosis (56 males and 74 females) ranging in age from 8 to 51 years underwent extended thoracoscopic T2-sympathectomy. In addition to a nearly 100% cure rate of hyperhidrosis palmaris, significant saving in operative time and hospital stay were achieved. High simultaneous cure rate (70.6%) and subjective improvement (17.4%) of excessive sweating of feet (hyperhidrosis plantaris) were also noted in the 109 cases followed up, and complications were minor. Extended thoracoscopic T2-sympathectomy is not only a time-saving method but also a very simple and effective method in the treatment of hyperhidrosis. It is worthy of being propagated worldwide.

Adolescent↗
PubMed1985

Lumbar sympathectomy: a single needle technique.

A single-needle lumbar sympathectomy technique is described which uses the tip of the 12th rib as a marker to determine the appropriate position for the insertion of the needle. Radiological screening is used to control final placement at the body of L3 and to visualize spread of radio-opaque phenol in the correct prevertebral plane. Following sympathectomy, fore-foot temperatures increased by a mean of 3 degrees C and lower leg blood flow doubled, these being accompanied by significant increases in ankle pressure index and venous oxygen tensions in the affected foot. These physiological improvements brought about resolution of ischaemic foot pain in 70% of patients at follow up 1 month later. As these results were not significantly different from those obtained in patients having two-needle sympathectomy, blockade with a single needle under x-ray control is considered to be an effective technique for the performance of neurolytic sympathectomy.

Aged↗
PubMed1995

Sciatic cryoneurolysis in rats: a model of sympathetically independent pain. Part 1: Effects of sympathectomy.

The purpose of this study was to evaluate the effects of preemptive and postlesion sympathectomy in the sciatic cryoneurolysis (SCN) model of neuropathic pain in rats. SCN in rats produces a prolonged significant mechanical allodynia (hypersensitivity to previously non-noxious mechanical stimuli) with no thermal hyperalgesia. In at least two other models, sympathectomy is effective in attenuating existing mechanical allodynia and thermal hyperalgesia or deterring their development after nerve injury. These models appear to mimic the direct sympathetic involvement characteristic of the clinical syndrome termed sympathetically maintained pain (SMP). To investigate these concepts in the SCN model, sympathectomy was performed prior to SCN in animals with established SCN-induced allodynia. Sympathectomy did not alter the pattern of existing allodynia or its development in this model. The results suggest that SCN is a useful and easily reproducible model of sympathetically independent pain (SIP).

Animals↗
PubMed1976

Pedal vasomotor tone following aortofemoral reconstructions: a randomized study of concomitant lumbar sympathectomy.

A prospective randomized trial was undertaken to evaluate effects of lumbar sympathectomy as an adjunct to reconstructive surgery of the lower limb. The objective of this study was to assess the early postoperative effect of these procedures on pedal vasomotor tone. A pedal arterial resistance index (PARI) at rest was derived from the ratio of the ankle-digit systolic pressure gradient and pedal blood flow measured plethysmographically. Studies were performed on 32 normal individuals and pre- and postoperatively in 29 patients undergoing aortic reconstruction, 12 of whom were randomly chosen to have lumbar sympathectomy. The mean postoperative PARI in 17 patients who had reconstructions alone was 42+/-7 (S.E.M.) units which approximated the preoperative PARI (43+/-9 units) and normal control values (45+/-6 units). In contrast, 12 patients who had a concomitant lumbar sympathectomy had a significant reduction in the postoperative PARI (8+/-1 units, Pless than 0.005). These initial results indicate that the addition of lumbar sympathectomy to an aortic reconstruction may enhance blood flow to the foot by significantly reducing outflow resistance.

Adult↗