Lumbar sympathectomy − literature review over the past 15 years
Authors:
M. Pekař 1,2; M. Mazur 1; A. Pekařová 2; J. Kozák 3; A. Foltýs 1
Authors place of work:
Chirurgické oddělení Vítkovické nemocnice a. s., Ostrava
primář: MUDr. M. Mazur, Ph. D.
1; Fyziologický ústav LF Masarykovy univerzity, Brno
přednosta: doc. PharmDr. P. Babula, Ph. D.
2; Vaskulární centrum, Interní oddělení Vítkovické nemocnice a. s., Ostrava
primář: MUDr. D. Kučera, Ph. D.
3
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 3, s. 101-106.
Category:
Review
Summary
Introduction:
Lumbar sympathectomy (LS) irreversibly damages a part of the sympathetic trunk and adjacent ganglia between L1 and L5, typically between L2 and L4. The first LS was performed in 1923. Initially, it used to be performed very often; however, with the progress of vascular and endovascular surgery its importance gradually continues to decline. The aim of the paper is to present literature review focusing on LS over the past 15 years.
Method:
Literature review of 113 academic articles found in academic journal databases.
Pathophysiology:
Irreversible interruption of the efferent innervation leads to relative vasodilation of small vessels in lower extremities (α1-receptors blockade), and it reduces the volume of sweat due to inactivation of eccrine glands and nociception from lower limbs.
Indication:
Raynaud´s phenomenon, thromboangitis obliterans, non-revascularizable peripheral arterial disease (PAD) (Fontain grade III-IV), hyperhidrosis, persistent pain in lower extremities, chronic pain of amputation stump, frostbites, chilblains.
Effect:
The three largest studies showed a positive effect in 63.6–93.4% cases of PAD and in 97%−100% cases of hyperhidrosis. The positive effect was defined as warmer lower extremities, increased blood flow, acceleration of chronic defects healing, sweating disappearance and pain reduction.
Conclusion:
Lumbar sympathectomy still remains a useful method in the treatment of above mentioned diseases if properly indicated.
Key words:
lumbar sympathectomy – Raynaud´s phenomenon – thromboangitis obliterans –peripheral arterial disease – hyperhidrosis
Zdroje
1. Govedarski V, Petrov I, Zahariev T, et al. [Adjuvant and individual application of lumbar sympathectomy at patient with arterial disease in lower limb]. Khirurgiia (Sofiia) 2010;19–23.
2. Kordiak J, Santorek-Strumiłło E, Brocki M, et al. The effects of lumbar sympathectomy in patients with chronic leg ischemia. Clin Exp Med Lett 2008;49:83–5.
3. Coventry BJ, Walsh JA. Cutaneous innervation in man before and after lumbar sympathectomy: Evidence for interruption of both sensory and vasomotor nerve fibres. ANZ J Surg 2003;73:14–8.
4. Huang J. The history of chemical lumbar sympathectomy. Anesthesiology 2000;93:U220–U220.
5. Nelson JW. Percutaneous radiofrequency lumbar sympathectomy. Tech Reg Anesth Pain Manag 2004;8:53–6.
6. Zoranović U, Jevtić M, Jovanović M, et al. Comparative analysis of lower extremities tissue perfusion by the use of perfusion scintigraphy method after hyperbaric oxygenation and lumbar sympathectomy. Vojnosanit Pregl 2009;66:563–9.
7. Bâtcǎ V, Jitea N, Albita O, et al. [The efficiency of lumbar transperitoneal laparoscopic sympathectomy--100 cases revue]. Chir Buchar Rom 2011;106:591–7.
8. Podlaha J, Roubal P, Gregor Z, et al. [Ischemic disease of the lower extremity and lumbar sympathectomy]. Bratisl Lekárske Listy 2000;101:229–30.
9. Coelho M, Kondo W, Stunitz LC, et al. Bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access for plantar hyperhidrosis in women. J Laparoendosc Adv Surg Tech 2010;20:1–6.
10. Tseng MY, Tseng JH. Endoscopic extraperitoneal lumbar sympathectomy for plantar hyperhidrosis: Case report. J Clin Neurosci 2001;8:555–6.
11. Hashmonai M. Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis. World J Surg 2011;35:54–5.
12. Rieger R, Pedevilla S, De Paula Loureiro M, et al. Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis. World J Surg. 2011;35:49–53.
13. Yoshida WB, Cataneo DC, Bomfim GAZ, et al. Chemical lumbar sympathectomy in plantar hyperhidrosis. Clin Auton Res 2010;20:113–5.
14. Reisfeld R. Endoscopic lumbar sympathectomy for focal plantar hyperhidrosis using the clamping method. Surg Laparosc Endosc Percutan Tech 2010;20:231–6.
15. Przywara S, Wroński J, Terlecki P, et al. Monitoring and assessment of effectiveness of videoscopic lumbar sympathectomy in patients with primary Raynaud’s phenomenon and hyperhydrosis by means of laser Doppler flowmetry. Acta Angiol 2004;10:57.
16. Talwar S, Prasad P. Single-stage lumbar sympathectomy and omentopexy: A new surgical approach towards patients with Buerger’s disease. Trop Doct 2001;31:73–5.
17. Straube S, Derry S, Moore R, et al. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome. Cochrane Database Syst Rev 2013; [on line] doi: 10.1002/14651858.CD002918.pub3.
18. Michálek P, Dutka J, Adamec M, et al. Percutaneous lumbar sympathectomy--presentation of a new trans-diskal approach. Rozhl Chir 2000;79:516–20.
19. Skugar’ Iu A, Logush NO, Fomenko VP. Reconstructive surgery on the femoro-popliteal segment in combination with lumbar sympathectomy. Khirurgiia (Sofiia) 2003;8–10.
20. Alkhudhairi DA, Ali I, Hashim MM, et al. Complete pain relief after combining radiofrequency and phenol for lumbar sympathectomy. Bahrain Med Bull 2013;35:1−5.
21. Manjunath PS, Jayalakshmi TS, Dureja GP, et al. Management of lower limb complex regional pain syndrome type 1: An evaluation of percutaneous radiofrequency thermal lumbar sympathectomy versus phenol lumbar sympathetic neurolysis - A pilot study. Anesth Analg 2008;106:647–9.
22. Rieger R, Pedevilla S, Lausecker J. Quality of life after endoscopic lumbar sympathectomy for primary plantar hyperhidrosis. Present. 9th Annual. Electr Util Environ Conf 2014:7p.
23. Chipde SS, Kumar J, Ranjan P. Acute renal failure due to bilateral ureteric necrosis following percutaneous chemical lumbar sympathectomy. Indian J Nephrol 2012;22:292–4.
24. Wijeyaratne SM., Seneviratne LN, Umashankar K, et al. Minimal access is not maximal safety: Pelviureteric necrosis following percutaneous chemical lumbar sympathectomy. BMJ Case Rep 2010; [on line] doi:10.1136/bcr.12.2009.2538
25. Shin HJ, Choi YM, Kim HJ, et al. Retroperitoneal hemorrhage from an unrecognized puncture of the lumbar right segmental artery during lumbar chemical sympathectomy: Diagnosis and management. J Clin Anesth 2014;26:671–5.
26. Rulli F, Galatà G, Micossi C, et al. Massive intestinal infarction following retroperitoneoscopic right lumbar sympathectomy. J Minimal Access Surg 2006;2:222–3.
27. Kokhan EP, Pinchuk OV, Kokhan VE. Lumbar sympathectomy in atherosclerosis obliterance of lower limb arteries and age of the patients. Khirurgiya 2000;41–3.
28. Matarazzo A, Rosati Tarulli V, Sassi O, et al. Possibilities at present for the application of lumbar sympathectomy in chronic occlusive arterial disease of the lower limbs. Minerva Cardioangiol 2002;50:363–9.
29. Shor NA, Zhadanov VI. Indications for lumbar sympathectomy and prognostication of its outcome in patients with obliterating atherosclerosis of the lower extremity arteries in chronic critical tissue ischemia. Klin. Khirurhiia Minist. Okhorony Zdorovia Ukraïny Nauk Tovarystvo Khirurhiv Ukraïny 2009;25–8.
30. Rieger R, Pedevilla S, Pöchlauer S. Endoscopic lumbar sympathectomy for plantar hyperhidrosis. Br J Surg 2009;96:1422–8.
31. Verma YS, Thakur JR, Sodhi SS. Evaluation of chemical lumbar sympathectomy for chronic arterial ischaemia of lower limb(s). J Anaesthesiol Clin Pharmacol 2007;23:391–4.
32. Bozkurt AK, Demirbas MY, Sayin AG, et al. A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger’s disease. Int Angiol 2006;25:162–8.
33. Torres Blanco Á, Gómez Palonés F, Ortiz Monzón E. Revisión: El papel de la simpatectomía lumbar en la cirugía vascular actual. Curr. Role Lumbar Sympathectomy Vasc Surg Engl 2015;67:200–5.
34. Ruiz-Aragón J, Márquez Calderón S. Effectiveness of lumbar sympathectomy in the treatment of occlusive peripheral vascular disease in lower limbs: Systematic review Med Clin (Barc.) 2010;134:477–82.
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