Sympathetic blockade and reversed saphenous vein by-pass grafting: an experimental study.

Abstract

The value of sympathetic blockade as an adjunct to femoropopliteal arterial reconstruction is disputed. The effect of lumbar sympathectomy and of pharmacological adrenergic blockade with intraarterial reserpine on the patency of experimental autogenous vein by-pass grafts was evaluated. Thirty-one grafts by-passing a chronic superficial femoral artery occlusion were inserted in adult mongrel dogs. The mean graft flow was reduced by a distal stenosis, below a known critical level of 60 ml per minute. In 10 grafts, no further procedure was done. These grafts occluded. In 11 grafts, an ipsilateral lumbar sympathectomy was done. Near normal flow was restored in 9 and these remained patent. No flow increase was achieved in 2 and these failed. In a further 10 grafts, 0.5 mg of reserpine was injected intra-arterially. In 9 of these grafts, near normal blood flow was restored and these remained patent. In one graft, no flow increase was achieved, and the graft failed. The role of sympathetic blockade in reconstructive surgery is discussed. It is concluded that a trial of intra-arterial reserpine in femoropopliteal arterial surgery is warranted.