Surgery of the sympathetic nervous system.

This article reviews the innervation of the arterial system of the lower extremity, lumbar sympathectomy in vascular surgery, lumbar sympathectomy for digital gangrene and in the prevention of major amputation of the lower extremity and substance P's role in neurogenic inflammatory modulation. Long-term results of lumbar sympathectomy and direct arterial bypass surgery have also been reviewed. In addition to the pilomotor, sudomotor and vasomotor actions of the sympathetic nervous system via its neurotransmitters, the molecular basis of the chronic neurogenic inflammatory reaction have been addressed with special attention to the discovery of substance P in the lumbar sympathetic chain and ganglia of human beings.

Distal thigh/arm index as a predictor of success for lumbar sympathectomy.

Data from 90 lumbar sympathectomies were reviewed to assess the role of a distal thigh/arm Doppler systolic index (DTAI) and of external magnetic flowmeter (MCBF) measurements for predicting patient outcome following lumbar sympathectomy. The presenting symptoms included impending gangrene, gangrene, rest pain, nonhealing ulcers, and disabling claudication. Of the 90 cases, clinical improvement occurred in 57% of the limbs.