Clinical parameters for predicting response to lumbar sympathectomy in patients with severe lower limb ischemia

A prospective study of 85 lumbar sympathectomies for inoperable peripheral vascular disease was conducted to analyze the correlation between lumbar sympathectomy, ankle/arm index (AAI), popliteal-brachial index (PBI), and the clinical presentation; and to study if predicted clinical criteria, single or combined, could be defined for selection of patients who might benefit from lumbar sympathectomy. Good results were obtained if at six months after surgery pain at rest was absent, ischemic ulcers had healed, and there were no major amputations. Seventy-seven percent of all limbs with a preoperative AAI greater than or equal to 0.3 had a good outcome in contrast to 94% failure for index less than 0.3 (p = .000000477). Sixty-nine percent of all limbs with PBI greater than or equal to 0.7 had a good outcome vs. 52% if index less than 0.7 (p = 0.199). Patients with rest pain, simple leg ulcers, and toe gangrene had a good outcome if the AAI greater than or equal to 0.3 and if the postoperative AAI increased by greater than or equal to 0.1. The PBI and diabetic status had no prognostic value.