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Ann Radiol (Paris) 1984 Apr-May ;27(4) :376-9
Dondelinger R, Kurdziel JC
J Mal Vasc 1989 ;14(4) :327-33
[Article in French]
Becquemin JP, Kassab M, Bellouard A, Brugiere P, Melliere D
Service de chirurgie vasculaire, Hopital Henri-Mondor, Creteil.
Lumbar sympathectomy, which is usually indicated in the arteritic patient in cases of severe ischemia and occlusion of leg arteries when bypass surgery is not feasible, can be performed surgically or by scanner-guided phenolization. Surgical sympathectomy was performed by resection of the 2nd, 3rd, 4th and 5th lumbar ganglia under general anesthesia by a retroperitoneal route. Chemical sympathectomy involved scanner-guided injection of phenol diluted 6.7% into the sympathetic nervous system at L3 and L4 level. This act, performed on outpatients, required no anesthesia. Prospective study of the early results (within one month) obtained with these two techniques in 428 patients indicates that rates of death, amputation and noteworthy complications for those less than 70 yr (table IV, VI and VIII) were respectively 4.7%, 8.5% and 7.4% for surgery, and 2.5%, 5% and 0% for phenolization ; for those greater than 70 yr the rates were respectively 12%, 11% and 10% for surgery, and 10%, 9% and 8% for phenolization. It may be concluded that phenolization of the sympathetic nervous system provides the same results as surgical sympathectomy but has the advantage of lower morbidity and shorter hospitalization (24 h vs 10 days). The results of these two techniques in terms of limb conservation are disappointing and markedly poorer than those of distal bypass surgery.
Anesthesiology 1991 Mar ;74(3) :459-63
Haynsworth RF Jr, Noe CE
Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas.
A new percutaneous approach to sympathectomy
using radiofrequency denervation has seemed to offer longer duration and
less incidence of postsympathetic neuralgia as compared to phenol sympathetic
blocks. To compare these techniques, 17 patients underwent either phenol
lumbar sympathetic blocks (n = 9) or radiofrequency denervation (n = 8).
Duration of sympathetic block was followed by a sweat test and temperature
measurements. Results indicate that 89% of patients in the phenol group
showed signs of sympathetic blockade after 8 weeks, as compared to 12%
in the radiofrequency group (P less than 0.05). Although the incidence
of post sympathetic neuralgia appears to be less with radiofrequency denervation,
further refinement of needle placement to ensure complete lesioning of
the sympathetic chain will be required before the technique can offer advantages
over current phenol techniques.
Zagzag D, Fields S, Romanoff H, Shifrin E, Cohen R, Beer G, Magora F
Percutaneous chemical lumbar sympathectomy
with alcohol (PCLSA) using computed tomography (CT) control was performed
in 8 patients suffering from advanced peripheral arterial occlusive disease.
PCLSA under CT guidance was found to be a simple and safe procedure. The
use of CT control added precision in the guidance of needle placement.
Positive results were obtained in all patients, without significant morbidity.
PCLSA may be an alternative to surgical sympathectomy.
Agressologie 1990 Apr ;31(4) :210-1
[Article in French]
Fondras JC, Dreyfus A, Loubrieu G, Ntarundenga U
Service de chirurgie vasculaire, Centre hospitalier general, Bourges.
Difficulties in surgical or neurolytic techniques of the sympathetic thoracic chain and the results have been controversial in the upper limbs arteriopathies. A percutaneous technique of neurolytic block under computed tomography in two patients, give evidence of efficacy on pain and skin ulcers.
Neurosurgery 1996 Apr ;38(4) :715-25
Division of Neurological Surgery, University of Massachusetts Medical School, Worchester, USA.
Between June 1979 and May 1994, I performed
148 unilateral or bilateral sympathectomies on 247 limbs in 110 patients
using a percutaneous radiofrequency technique, usually on an outpatient
surgery basis. Patient ages ranged from 10 to 81 years, with 45 male and
65 female patients. Four patients had unsuccessfully undergone prior open
surgical sympathectomy. Patients suffered from hyperhidrosis, vascular
occlusion, Raynaud's disease or other chronic vasculopathies, painful causalgia
or reflex sympathetic dystrophy, or Prinzmetal's angina. The sympathectomy
technique has evolved over this 15-year period and is currently in its
third phase. Changes in the procedure were based on anatomic and clinical/radiographic
correlations and careful patient follow-up. Current modifications have
reduced the frequency of both early and late failures. The present technique
(Phase III) relies on neuroleptanalgesia with superficial local anesthesia
only and does not require general anesthesia, intubation, or lung collapse.
Two 18-gauge radiofrequency TIC needle electrodes (Radionics, Burlington,
MA) are used. A series of three lesions is rostrocaudally made at each
of the ganglion sites selected in an attempt to destroy the entire fusiform
ganglion. Lesion sites are targeted by C-arm fluoroscopy and electrical
stimulation, which produces a threshold of sensory awareness of > 1.0 V.
Lesion effectiveness is monitored by bilateral finger plethysmography and
hand skin temperature measurement. With the Phase III technique, the sympathetic
activity in 96% of operated limbs after 2 years and in 91% of operated
limbs after 3 years continues to be completely or largely interrupted.
By comparison, I achieved similar success in 83 and 72% operated limbs
with the Phase I technique and in 77 and 71% with the Phase II technique.
Symptomatic pneumothorax, in six patients, has been the only serious complication.
When necessary, a subsequent operation can easily be performed and is effective.
Ann Med Interne (Paris) 1996 ;147(5) :299-303
[Article in French]
Wazieres BD, Bartholomot B, Fest T, Combes J, Kastler B, Dupond JL
Service de Medecine Interne, Hopital Jean-Minjoz, Besancon.
We report our experience with percutaneous
thoracic sympathectomy using computed tomography-guided injection of phenol
in 17 patients. A total of 24 neurolyses were performed in outpatients.
Indications were palmo-plantar hyperhidrosis in 10 patients and severe
Raynaud phenomena in 7 cases (Sharp's syndrome = 2. sclerodermia = 3, Raynaud's
syndrome = 1, digital arteritis = 1). Conventional treatment had failed
in all patients. Cure was obtained in all cases of hyperhidrosis. For the
patients with critical ischemia, there was temporary improvement which
allowed wound healing, but recurrence was the rule within 6 months on average.
Complications included pneumothorax, brachial nevralgia which persisted
for 4 months and 3 partial Claude-Bernard-Horner syndromes. This technique
is an inexpensive reliable method which can be used in case of contraindications
or to avoid certain complications of endoscopic surgery which remains the
standard treatment. Percutaneous sympatholysis in thus an interesting
Semin Laparosc Surg 1994 Dec ;1(4) :241-253
Department of Surgery, Ninewells Hospital
and Medical School, Dundee,
Denervation of the sympathetic nerve can
be accomplished with much less operative trauma by using the endoscopic
surgical approach. Although endoscopic thoracic sympathectomy is not new,
the techniques and the extent of denervation have not been standardized.
The anatomic appearances and configurations of the sympathetic chain are
explained, and various procedures, including ramisections, interganglionic
sympathectomy, and ganglionectomy, are reviewed. Thoracoscopic approaches,
operative techniques, and potential complications are discussed.
Radiol Clin North Am 1998 May ;36(3) :509-21
Link SC, el-Khoury GY, Guilford WB
University of Minnesota, Minneapolis, USA.
Epidural steroid injections and selective
nerve root blocks currently are considered standard techniques in the diagnosis
and treatment of back pain. The targeted epidural and perineural
steroid injection with nerve block is a new technique that combines an
epidural steroid injection and a nerve block. Radiologists are best
suited for performing these procedures because of their training and skills
in fluoroscopy and needle procedures.
J Pain Symptom Manage 1995 Feb ;10(2) :98-104
Gleim M, Maier C, Melchert U
Clinic of Anesthesiology and Intensive Care Medicine, Christian-Albrechts University, Kiel, Germany.
Thirty patients with angiographically proven peripheral vascular disease (PVD) and intermittent claudication were treated with percutaneous lumbar neurolytic sympathetic blockade (NSB) using 1.5 mL ethanol 95%. Claudication had been progressive in all patients during conservative treatment. Median (range) painless walking distance increased from 95 (10-200) meters (m) before to 355 (25-1003) m immediately after NSB. Further improvement was seen during the 1-year follow-up, with two exceptions : one patient lost a leg after acute arterial embolism and another patient deteriorated after 6 months. In the latter case, a second NSB improved the walking distance again. One case of transient mild neuralgia of the L3 dermatome occurred. 31P-magnetic resonance investigations of the calf muscles before, during, and after a treadmill exercise were performed in seven patients : 1 week after NSB, the postexercise recovery of phosphocreatine was accelerated in all patients compared to the pre-NSB values. The accelerated recovery suggests an improved post-ischemic metabolic situation after chemical sympathectomy.