Among atheromatous occlusive arterial disease of the lower limbs, chro
nic sub-popliteal arterial occlusions refer an heterogenous group of p
atients. In this medical condition, lumbar sympathectomy constitutes a
classical possible treatment. Actually, the beneficial effect of symp
athectomy has never been confirmed by controlled randomised trials. In
this particular and uncomfortable situation, it is only possible to l
ist non indications for sympathectomy: asymptomatic patient, claudicat
ion, critical ischemia, limb salvage, and combination with vascular su
rgery. Lumbar sympathectomy deserves a controlled evaluation in patien
ts with a small foot ischemic ulceration without hemodynamic critical
ischemia i.e. systolic toe pressure > 30 mm Hg and/or ankle systolic p
ressure > 50 mm Hg.