Sympathectomy in Postvascular Surgical Patients with Severe Pain in Distal Limb and/or Small Ulcers

Abstract

Introduction: Sympathectomy is used principally in patients of inoperable peripheral vascular disease, small vessel disease, and vasospastic disease. It is useful to alleviate symptoms of rest pain and as an adjunct to heal ischemic ulcers. Aim and Objective: This is a clinical study to evaluate the role of sympathectomy in postvascular surgical patients with persistent pain in distal limb (causalgia) with or without ischemic ulcers on the foot or hand. Materials and Methods: This study was performed between February 2015 and February 2020. We did 823 arterial surgical interventions including embolectomies, endarterectomy with patch arterioplasty, and interposition grafting in upper or lower limb vessels. These patients were diagnosed on clinical bases and with investigational modalities such as arterial Doppler study and computed tomography angiography. All these patients had chronic vascular obstruction. Out of them, we selected 54 patients having persistent pain distal limb (causalgia) not relieved by medications. Besides causalgia, 24 patients had ischemic ulcers either on foot or hand. Postoperative arterial Doppler study was satisfactory in these patients. Their complaint persisted for 3–4 months in spite of all medications. Chemical sympathectomy was tried in 21 patients but was ineffective. We did thoracic sympathectomy in 28 patients and lumbar sympathectomy in 26 patients on side affected. Observation and Results: There were 46 males and 8 females. Majority of these patients were in active phase of life with a mean age of 35 (±2). Pain was relieved in all patients. Ischemic ulcers present in 24 patients also healed within 3–6 weeks. Conclusion: Although no clear guidance exists for the role of sympathectomy in postsurgical patients, we observe it is a boon for postvascular surgical patients with persistent pain and small ischemic ulcers.