Abstract No. 309 - Percutaneous lumbar sympathectomy: technique and clinical outcome review

Abstract

Purpose Percutaneous sympathectomy has been used for treatment of complex regional pain syndromes (1), plantar hyperhydrosis (2,3), and peripheral vascular disease (PVD) with critical limb ischenia (CLI). We report technique of CT guided percutaneous sympathectomy using anhydrous ethanol in patients with CLI. Materials and Methods CT guided percutaneous lumbar sympathetic ablations were performed in a group of 5 patients (avg. age 68, range 61-82) with advanced PVD (Fontaine Stage IV). All had rest pain, clinical CLI and impending amputation. Patients were assessed for preprocedure and post procedure pain, color and warmth after the procedure, 4 hrs later and 2-3 months later. Results All patients showed a positive response of increased warmth, color, flushing and lessening of pain at the end of the procedure. Over three months follow-up, none underwent amputation, and 4 of the 5 (80%) maintained residual improvement in color and warmth. One returned to baseline appearance, but without amputation. No procedural complications were encountered. Conclusion CT guided lumbar sympathectomy with anhydrous ethanol is safe and effective in advanced PVD to stave off impending amputation. CT guidance increases accuracy of needle placement, decreases the volume of ablative chemical needed and may be able to reduce the incidence of complications reported in the literature (5).