Retroperitoneoscopic lumbar sympathectomy therapeutic options in lower limb peripheral arterial disease which not allowed revascularization procedure

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[学科分类] 外科医学

[关键词] AIM: To assess the effectiveness of retroperitoneoscopic lumbar sympathectomy in lower limb peripheral arterial disease. METHODS: We analyzed 50 lumbar sympathectomies (47 men and 3 women;aged between 31 and 79 years) performed in the last five years (2007-2011) for the lower limb peripheral arterial disease (PAD). Diagnosis and staging were established on the clinic and imaging findings (Doppler ultrasound;arteriography). Lumbar sympathectomy (LS) was our therapeutic option for PAD with poor vascular axis or associated life threatening co-morbidities;which not allowed revascularization procedures. Lumbar sympathectomy was performed by retroperitoneoscopic approach in 49 (98%) cases;with a conversion rate of 6.12% (3 cases) and by classic approach in 1 (2%) case;we also performed concomitant necrosectomy for associated trophic lesions in 12 cases. RESULTS: In 42 (84%) cases we noted good outcomes significant or complete remission with disappearing of pain (assessed by visual analog scale) and increasing of the local skin temperature (measured by an digital infrared thermometer);in other 6 (12%) cases the results were mediocre. Unfavorable results;requiring amputation;were noted in 2 cases (4%). We encountered no postoperative deaths. CONCLUSIONS: The retroperitoneoscopic lumbar sympathectomy is still an efficient therapeutic alternative for the treatment of PAD;when the revascularization procedures are impossible or contraindicated.