THE ROLE OF SYMPATHETIC GANGLIONECTOMY IN TREATMENT OF LIMB OBLITERATIVE VASCULAR DISEASES

A.D. Gaibov, D.D. Sultanov, M.Sh. Bahrutddinov
Hospital Surgery Department Tadjik State Medical University
Dushanbe, Tadjikistan

Results of treatment of 75 patients with distal lesions of upper (16 patients) and lower (59 patients) limb vessels are presented. Thromboangiitis obliterans was registered in 66 patients, thoracic outlet syndrome with pronounced Raynaud's phenomenon – in 9 patients. Thirty one patients suffered from II-grade ischemia, 69% – from lll-IV-grade ischemia (according to Fontaine classification). Circulation in extremities was assessed by rheovasography and Doppler sonography. Peripheral vessels were also investigated by angiography. Four variants of sympathectomy were executed: I variant: isolated ganglionectomy in thoracolumbar segment of sympathetic trunk was fulfilled in 23 patients with thromboangiitis obliterans including 16 patients with lower limb, and 7 patients with upper limb involvement. II variant: combined sympathectomy and major vessel reconstruction (16 patients) or catheterization of inferior epigastric artery (10 patients) for intra-arterial infusions. III variant: combined selective cervicothoracic sympathectomy and decompressive procedures (9 patients). IV variant lumbar sympathectomy with adrenal resection (9 patients). Postoperatively ischemic regression was obtained in 62 from 75 patients (82.6%). Unsatisfactory results were observed in 13 patients, including 6 patients with sympathectomy and 7 patients with adrenal resection. All these patients underwent successive limb amputation. The authors conclude that despite the development of various original methods of limb revascularization for peripheral occlusions, different variants of sympathectomy are quite acceptable for certain category of patients and are equal in efficiency to other methods.

KEY WORDS: sympathectomy, limb obliterative vascular diseases.

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