VINTAGE TECHNIQUE IN VASCULAR SURGERY: LUMBAR SYMPATHECTOMY IN CRITICAL LIMB ISCHEMIA

  • José Luis Durán Mariño Department of Vascular Surgery; Lucus Augusti Universitary Hospital, Lugo. Spain
  • Eva Lucía Martínez Gallego Department of Vascular Surgery; Lucus Augusti Universitary Hospital, Lugo. Spain
  • Eva Pérez Carballo Department of Vascular Surgery; Lucus Augusti Universitary Hospital, Lugo. Spain
  • Francisco Xavier Rielo Arias Department of Vascular Surgery; Lucus Augusti Universitary Hospital, Lugo. Spain
  • Juan Pena Holguín Department of Vascular Surgery; Lucus Augusti Universitary Hospital, Lugo. Spain
  • Laura Velásquez Castañeda Department of Vascular Surgery; IMED Levante Hospital, Benidorm-Alicante. Spain
Keywords: Critical limb ischemia, Buerguer's disease, Lumbar sympathectomy

Abstract

Introduction: Tromboangiitis Obliterans or Buerguer's disease is one of the expresions of the peripheral arterial disease; its main feauture is the absence of average distal outflow that precludes direct revascularization surgery; lumbar sympathectomy was carried out to treat this condition with acceptable results but nowadays this technique is described as obsolete; many young vascular surgeons have not even heard about it and most of them have never seen a lumbar sympathectomy for the treatment of patients with critical limb ischemia.

Case report: A 39-year-old woman admitted with critical limb ischemia due to popliteal artery occlusion without average distal outflow, treated by a lumbar sympathectomy as a resource technique.

Discussion: Today, endovascular treatment is the first option for the critical limb ischemia in most cases; althoug tromboangiitis obliterans is less frequent nowadays, exists, and this is one of the situations where endovascular treatment does not work; what's more, direct surgery is also not possible.

Conclusions: Lumbar sympathectomy can work not only in this scenary of Buerguer's disease; it can be used as resource technique when the first approach with direct surgery has failed and there is not more options to limb salvage; thus, lumbar sympathectomy should be part of the therapeutic arsenal of any vascular surgeon.

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Published
2021-06-03
Section
Clinical Case