Vascular Responses in Diabetic Peripheral Neuropathy

Lumbar Sympathectomy-Myers and Irvine BRmsH 883 the operation.It is believed that these cases are few in number and that the explanation for the response has yet to be provided. SummaryThe value of lumbar sympathectomy for intermittent claudication is disputed.Improvement would imply persistent release of collateral or vasomotor tone.It is doubtful whether afferent fibres are carried in the sympathetic trunk in sufficient number to be of significance.Thirty-one patients having 40 lumbar sympathectomies for intermittent claudication were studied before and 10 to 14 days after operation by strain-gauge plethysmography.Measurements were made of the resting flow, of the peak flow and time of its development during reactive hyperaemia, and of the distal arterial pressure in the calf muscle.No statistically significant increase could be demonstrated after sympathectomy in any of these parameters in the group as a whole.Nor could significant change be shown according to the clinical response to the operation, to the severity or duration of the symptoms, or to the site of the occlusion or extent of the disease.The flows both before and after sympathectomy were higher in the group showing clinical improvement, suggesting that spontaneous remission is more likely to occur when the disease is less severe.It is considered that there is no objective evidence of consistent haemodynamic benefit from lumbar sympathectomy for intermittent claudication.