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End results of thoracolumbar sympathectomy for advanced essential hypertension
Insights
Thoracolumbar sympathectomy for essential hypertension showed a 16% mortality. More extensive procedures yielded better results but increased mortality, suggesting a need for further data to balance outcomes and risks.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Vascular Surgery
Background:
- Essential hypertension is a significant health concern, often requiring surgical intervention in advanced stages.
- The study period (1942-1948) predates many modern antihypertensive therapies.
- Patient selection for surgery was guided by specific clinical judgment criteria.
Purpose of the Study:
- To evaluate the outcomes and mortality associated with thoracolumbar sympathectomy for essential hypertension.
- To compare the efficacy and risks of different extents of sympathectomy.
- To determine the role of sympathectomy in managing advanced hypertensive vascular disease.
Main Methods:
- Analysis of 473 patients undergoing thoracolumbar sympathectomy between 1942 and 1948.
- Comparison of outcomes between limited and more extensive sympathectomy procedures (Smithwick procedure variations).
- Inclusion of total sympathectomies involving the stellate ganglion in later cases.
Main Results:
- Overall mortality was 16% (79 deaths), with 8% in-hospital mortality (38 deaths).
- Leading causes of in-hospital death: cerebral accident, cardiac failure, renal insufficiency.
- Leading causes of out-of-hospital death: cardiac failure, cerebral accident, renal insufficiency.
- More extensive sympathectomies showed improved results but higher mortality rates.
Conclusions:
- Thoracolumbar sympathectomy has a role in treating hypertensive vascular disease.
- In advanced cases, the procedure primarily offers palliative benefits.
- Further data is required to definitively conclude if complete sympathectomy is superior to less extensive procedures, considering mortality risks.
Abstract:
In a six-year period from February 1942 to February 1948, 473 patients (185 males and 288 females) were operated upon for essential hypertension and most of them were in advanced stages of hypertensive disease.Patients were selected or rejected for operation on the basis of a set of rules drawn to guide clinical judgment. The total of deaths in and out of the hospital over this period was 79 or a total mortality of 16 per cent. There were 38 inhospital deaths, or a mortality of 8 per cent. The causes of deaths occurring in the hospital were in the following order: cerebral accident, cardiac failure, and renal insufficiency. The out-of-the-hospital deaths were in the following order: cardiac failure, cerebral accident, and renal insufficiency. Operations done early in the series followed the Smithwick procedure from T-9 through L-2, but later the minimal procedure was extended from T-3 through D-3, and in addition about 40 total sympathectomies which included the stellate ganglion were done. Results from the more extensive operation were better than those from the lesser procedure, but the mortality also was greater. Conclusion that complete or nearly complete sympathectomy is preferable to a less extensive procedure must await the collection of more data which can be used in weighing the respective end results against the mortality. Thoracolumbar sympathectomy has a definite place in the treatment of hypertensive vascular disease, but its role in advanced cases is chiefly that of palliation.
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