[The past, present and future of lumbar sympathectomy]

The ischemic extremities treatment in a precarious phase has been standardized in the two last decades with a significance extremities savement. But the ischemia of the interdigital vessels and at the microcirculation is still a defiance. We expose the hiperemiant surgery past. We describe the experience of four years in Centre Hospitalari-Unitat Coronaria, Manresa, with 21 lumbar sympathetic ablation in patients without distal pulse, ankle/arm index by Doppler effect between 0 and 0.6 and angiographies without distal bed images, with 13 successes, 2 exitus by M.A.I., 3 amputations and a lung edema. We finish with a futuristic vision that suggest alternatives for the usage of the lumbar sympathectomy according to the medical advances in the coming time for available the ischemic extremities.