Radiofrequency neurolysis of the paravertebral sympathetic chain: a single-centre retrospective analysis
DOI:
https://doi.org/10.48750/acv.606Palavras-chave:
Hyperhidrosis, Radiofrequency neurolysis, Sympathetic nervous system, Lumbar sympathectomyResumo
INTRODUCTION: Lumbar sympathectomy has historically been a widely used technique in vascular surgery. The advent of minimally invasive approaches capable of definitively interrupting the sympathetic chain at different levels may renew interest in sympathectomy, broadening its scope beyond current indications. This renewed interest could extend its potential benefits to conditions where open surgery is not commonly performed nowadays. This study aims to evaluate the efficacy and safety of radiofrequency neurolysis of the paravertebral sympathetic chain across a range of clinical conditions.
METHODS: This is a retrospective, single-centre study that included patients who underwent sympathetic chain interruption using percutaneous radiofrequency ablation under local anaesthesia between September 2022 and February 2024. The procedures targeted either the lumbar or the thoracic levels. The indications for the procedure were obstructive arterial disease, complex regional pain syndrome and primary focal hyperhidrosis. Patients underwent re-evaluated during follow-up appointments aimed at monitoring the benefits, complications and adverse effects of surgery.
RESULTS: This cohort comprises 23 patients, of whom 83% are female. The average age of the patients is 46.9 ± 17.4 years. The primary indications for lumbar radiofrequency neurolysis of the paravertebral sympathetic chain are plantar hyperhidrosis (n = 8, 35%) and rest ischemic pain (n = 7, 30%). During this period, 49 procedures were performed, with 39 of them at the lumbar level. Most of the patients underwent bilateral procedures (53%). More than 88% of procedures result in clinical improvement for patients, with complete resolution occurring in around 35% of cases. Lumbar radiofrequency neurolysis is associated with no complications.
CONCLUSION: Lumbar radiofrequency neurolysis of the paravertebral sympathetic chain presents as a minimally invasive and safe alternative approach to abolishing sympathetic tone, although it is currently less effective than open surgery. It may potentially be applied to patients formally indicated for lumbar sympathectomy.
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