fluoroscoPy guided cHeMical luMbar syMPatHectoMy for lower liMb iscHaeMic ulcers

Abstract

The purpose of this study was to assess the effectiveness of chemical lumbar sympathectomy in
relieving pain and healing ischaemic ulcers in patients with peripheral vascular diseases. Thirtyone
consecutive patients with ischaemic/ gangrenous lower limb ulcers, referred to the BPKIHS,
Pain Clinic were observed prospectively after chemical lumbar sympathectomy using modified
Reid Technique with 3 ml of 70% alcohol each at L2 and L3 level under fluoroscopic guidance.
Pain relief and ulcer healing were noted in the follow up. Moreover, patients’ abilities to resume
at least part of their day to day work were also noted at three months follow up. Of the total 31
patients, 16 had Buerger’s disease and the remaining 15 had non-Buerger’s ischaemic ulcers of
which 7 were diabetic. There was significant decrease in the pain score from mean±SD of 8.3±0.9
(pre-block) to 4.2±2.5 (post-block after 3 days) in zero to 10 Numerical Analogue Scale (NAS). By
3 months, 6 patients declined for follow up; 19(76%) of the remaining 25 patients reported pain
relief, 18(72%) reported healing or decrease in the size of ulcers and 11(44%) were able to resume
at least part of their usual work. Minor complications occurred in 5 patients and amputation was
needed in 6 patients. Fluoroscopy- guided chemical lumbar sympathectomy is feasible, safe and
effective in relieving pain and promoting ulcer healing in patients with ischaemic lower limb ulcers
Key Words: Buerger’s disease; Chemical lumbar sympathectomy; Ischaemic ulcers.