CT-GUIDED LUMBAR SYMPATHECTOMY - RESULTS AND ANALYSIS OF FACTORS INFLUENCING THE OUTCOME

Purpose: To prospectively analyze the effectiveness of computed tomogr aphy-guided percutaneous lumbar sympathectomy (CTLS) in patients with peripheral arterial occlusive disease in relation to angiographic find ings and vascular risk factors. Methods: Eighty-three patients were tr eated by CTLS. After clinical evaluation of the risk profile and diagn ostic intraarterial digital subtraction arteriography, 14 patients und erwent unilateral, and 69 bilateral one-level treatment. Follow-up stu dies took place on the day following the intervention, after 3 weeks, and after 3 months. Results: A total of 152 interventions were perform ed in 83 patients. After 3 months, clinical examination of 54 patients (5 patients had died, 24 were lost to follow-up) revealed improvement in 46% (25/54), no change in 39% (21/54), and worsening (amputation) in 15% (8/54). There was no significant statistical correlation among any of the analyzed factors (diabetes mellitus, arterial hypertension, smoking, hyperlipidemia, obesity, hyperuricemia, number of risk facto rs, ankle-arm index, and angiography score) and the outcome after CTLS . Three major complications occurred: one diabetic patient developed a retroperitoneal abscess 2 weeks after CTLS, and in two other patients ureteral strictures were detected 3 months and 2 years after CTLS, re spectively. Conclusion: As no predictive criteria for clinical improve ment in an individual patient could be identified, CTLS, as a safe pro cedure, should be employed on a large scale in patients who are unsuit able for treatment by angioplasty or revascularization.