Lumbar sympathectomy in peripheral vascular disease.

Abstract

THE AMOUNT of arterial obstruction which results from any peripheral vascular disease is the sum of the anatomic obstruction in the diseased blood vessel plus the constriction resulting from vasomotor impulses. These impulses may be thought of as those which are normally present producing normal vascular tone and those which are present because of abnormal reflexes. Such reflexes may arise in the area of disease in the blood vessels and, after passing through efferent and afferent loops contained within the sympathetic nervous system, return to the same vascular bed to produce abnormal vasoconstriction. Sympathectomy was early used in those forms of peripheral vascular disease in which there is a large vasospastic element. The first indication for such surgical treatment was considered to be Raynaud's disease and scleroderma. More recently the operative procedure has been used with greater acceptance in peripheral vascular conditions in which the amount of vasomotor tone, depending