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Angiologia e Cirurgia Vascular

 ISSN 1646-706X

MARINO, José Luis Durán et al. Vintage Technique in Vascular Surgery: Lumbar sympathectomy in critical limb ischemia. []. , 17, 1, pp.47-50.   31--2021. ISSN 1646-706X.

Introduction:

Tromboangiitis Obliterans or Buerguer's disease is one of the expresions of the peripheral arterial disease; its main feauture is the absence of average distal outflow that precludes direct revascularization surgery; lumbar sympathectomy was carried out to treat this condition with acceptable results but nowadays this technique is described as obsolete; many young vascular surgeons have not even heard about it and most of them have never seen a lumbar sympathectomy for the treatment of patients with critical limb ischemia.

Case report:

A 39-year-old woman admitted with critical limb ischemia due to popliteal artery occlusion without average distal outflow, treated by a lumbar sympathectomy as a resource technique.

Discussion:

Today, endovascular treatment is the first option for the critical limb ischemia in most cases; althoug tromboangiitis obliterans is less frequent nowadays, exists, and this is one of the situations where endovascular treatment does not work; what's more, direct surgery is also not possible.

Conclusions:

Lumbar sympathectomy can work not only in this scenary of Buerguer's disease; it can be used as resource technique when the first approach with direct surgery has failed and there is not more options to limb salvage; thus, lumbar sympathectomy should be part of the therapeutic arsenal of any vascular surgeon.

: Critical limb ischemia; Buerguer's disease; Lumbar sympathectomy.

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