[Ambulatory, CT-assisted lumbar sympathicolysis in patients with severe peripheral artery disease: influence on peripheral blood flow and clinical outcome].

PURPOSE: The clinical improvements reported by patients after lumbar sympathicolysis have been verified and quantified by colour-coded duplex sonography (CCDS) in this study.

PATIENTS AND METHODS: CT-assisted lumbar sympathicolysis was performed on 136 patients (105 men, 31 women; mean age 66.1; range: 43-82 years) with PAOD (Fontaine stage II b-IV) on an outpatient basis after exhaustive surgical and interventional therapy. Puncture was performed via a dorsolateral approach, a 22 G Seibel-Grönemeyer Chiba biopsy needle was placed intercavovertebrally or interaortovertebrally at the level of the arch pedicle of the third lumbar vertebral body. A medication mixture consisting of 96% alcohol, 0.5% Carbostesin and added amounts of contrast medium was administered when the needle was correctly positioned. An average of 10 mL (6-12 mL) of the sympathicolytic agent was administered; in all cases only one side was treated per sitting. Before and around 120 min after the intervention, and 6 months post-intervention, the systolic and end-diastolic flow velocities, and blood volumes per minute were determined by CCDS. Additionally, the retroperitoneal space was examined by ultrasound after 6 months. The clinical outcome and the complications were assessed by a standardised questionnaire.

RESULTS: In all patients, sympathicolysis was performed without technical complications. Starting on day 1 post-intervention, 4 patients complained of dysaesthesia in the inguinal and thigh area, another patient developed an erectile dysfunction although all these complications were completely reversible. 131/136 (96%) of the patients showed a significant increase in peripheral circulation immediately after the intervention, whereby a significant persistent effect was also seen in 120/136 (88%) after 6 months. In particular, patients in PAOD stages III and IV gained a clinical benefit.

CONCLUSION: Lumbar sympathicolysis is a therapeutic option in severe PAOD that is low in complications, effective, minimally invasive and can be performed on an outpatient basis; it should be considered after angiographic-interventional and surgical measures have been exhausted. The significant clinical improvements can be explained in part by the improvement in perfusion as verified by CCDS.