Pedal vasomotor tone following aortofemoral reconstructions: a randomized study of concomitant lumbar sympathectomy

A prospective randomized trial was undertaken to evaluate effects of lumbar sympathectomy as an adjunct to reconstructive surgery of the lower limb. The objective of this study was to assess the early postoperative effect of these procedures on pedal vasomotor tone. A pedal arterial resistance index (PARI) at rest was derived from the ratio of the ankle-digit systolic pressure gradient and pedal blood flow measured plethysmographically. Studies were performed on 32 normal individuals and pre- and postoperatively in 29 patients undergoing aortic reconstruction, 12 of whom were randomly chosen to have lumbar sympathectomy. The mean postoperative PARI in 17 patients who had reconstructions alone was 42+/-7 (S.E.M.) units which approximated the preoperative PARI (43+/-9 units) and normal control values (45+/-6 units). In contrast, 12 patients who had a concomitant lumbar sympathectomy had a significant reduction in the postoperative PARI (8+/-1 units, Pless than 0.005). These initial results indicate that the addition of lumbar sympathectomy to an aortic reconstruction may enhance blood flow to the foot by significantly reducing outflow resistance.