Arteriograms in Ischemic Limbs Worsened After Lumbar Sympathectomy

Sympathectomy for occlusive vascular disease has had a hard time.—de Takats The present status of sympathectomy in the treatment of arterial occlusive disease is unsettled. It is no longer the mainstay of operative treatment, as it was in 1952.11Neither is it merely an adjunctive procedure to be done routinely in combination with arterial reconstruction.5,18Its true role may defy scientific analysis4or it may be the treatment of choice for aged persons19or others unsuited for angioplasty. The position of lumbar ganglionectomy would be clearer if a true prediction regarding its effects could be made in a given patient. Despite the many clinical and laboratory methods of testing which have been used, no single examination emerges which reliably assesses preoperatively what the operation will accomplish.6,16Such estimation of sympathectomy results is neither impossible as suggested by Nelson and Trimble,13nor 90%