Lumbar sympathectomy: a place in clinical medicine

Currently lumbar sympathectomies are infrequently performed because the effectiveness of the procedure is unclear. The previous indication of limb-threatening ischemia has been usurped by distal arterial reconstruction. Some vascular surgeons feel there is no remaining clinical role. This paper suggests four categories of patients, represented by five case reports, where lumbar sympathectomy may prove beneficial: 1) Hypertensive patients with painful leg ulcers; 2) Toe and foot amputations in which arterial reconstruction is not feasible; 3) Posttraumatic causalgia (sympathetic dystrophy); 4) As an adjunct to distal graft bypass.