These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: [Ambulatory, CT-assisted lumbar sympathicolysis in patients with severe peripheral artery disease: influence on peripheral blood flow and clinical outcome].
    Author: Nickel J, Brinckmann W, Andresen R.
    Journal: Zentralbl Chir; 2008 Aug; 133(4):349-54. PubMed ID: 18702019.
    Abstract:
    PURPOSE: The clinical improvements reported by patients after lumbar sympathicolysis have been verified and quantified by colour-coded duplex sonography (CCDS) in this study. PATIENTS AND METHODS: CT-assisted lumbar sympathicolysis was performed on 136 patients (105 men, 31 women; mean age 66.1; range: 43-82 years) with PAOD (Fontaine stage II b-IV) on an outpatient basis after exhaustive surgical and interventional therapy. Puncture was performed via a dorsolateral approach, a 22 G Seibel-Grönemeyer Chiba biopsy needle was placed intercavovertebrally or interaortovertebrally at the level of the arch pedicle of the third lumbar vertebral body. A medication mixture consisting of 96% alcohol, 0.5% Carbostesin and added amounts of contrast medium was administered when the needle was correctly positioned. An average of 10 mL (6-12 mL) of the sympathicolytic agent was administered; in all cases only one side was treated per sitting. Before and around 120 min after the intervention, and 6 months post-intervention, the systolic and end-diastolic flow velocities, and blood volumes per minute were determined by CCDS. Additionally, the retroperitoneal space was examined by ultrasound after 6 months. The clinical outcome and the complications were assessed by a standardised questionnaire. RESULTS: In all patients, sympathicolysis was performed without technical complications. Starting on day 1 post-intervention, 4 patients complained of dysaesthesia in the inguinal and thigh area, another patient developed an erectile dysfunction although all these complications were completely reversible. 131/136 (96%) of the patients showed a significant increase in peripheral circulation immediately after the intervention, whereby a significant persistent effect was also seen in 120/136 (88%) after 6 months. In particular, patients in PAOD stages III and IV gained a clinical benefit. CONCLUSION: Lumbar sympathicolysis is a therapeutic option in severe PAOD that is low in complications, effective, minimally invasive and can be performed on an outpatient basis; it should be considered after angiographic-interventional and surgical measures have been exhausted. The significant clinical improvements can be explained in part by the improvement in perfusion as verified by CCDS.
    [Abstract] [Full Text] [Related] [New Search]