[Reconstructive surgery on the femoro-popliteal segment in combination with lumbar sympathectomy]

Long-term results of 660 reconstructive surgeries on the arteries of the femoro-popliteal segment performed from 1975 to 2002 are analyzed. Two hundred and twenty-eight (34.5%) of them were combined with lumbar sympathectomy (LSE) on the affected side. It was demonstrated that LSE influences outcomes of reconstructions on the femoro-popliteal segment. This influence depends on a primary degree of leg ischemia. At the stage of intermittent claudication LSE permits to improve patency of the femoro-popliteal segment, salvage of the leg, to decrease the rate of postoperative complications due to reduction of thrombosis and purulation rates. The rate of cardiovascular complications increases. In critical limb ischemia effect of LSE is opposite. It increases the rate of repeated occlusions and amputations compared with reconstructive surgeries without LSE. The rate of postoperative complications also increased due to thrombosis and cardiovascular complications. It is concluded that LSE is the factor improving outcomes of reconstructive surgery on the femoro-popliteal segment, but it must be used differentially. It is necessary to perform LSE during all reconstructive surgeries in patients with intermittent claudication and without serious cardiovascular diseases. In critical limb ischemia and serious concomitant cardiovascular diseases LSE must be avoided.