Phenol Lumbar Sympathetic Block in Diabetic Lower Limb Ischemia

BACKGROUND: Patients with arteriosclerotic peripheral vascular disease and lower limb ischemia have painful ulceration or incipient gangrene of the lower limb with intractable rest pain. The arteriosclerotic changes may preclude any surgery other than amputation. METHODS: We examined whether chemical sympathectomy could relieve pain, arrest gangrene and postpone amputation, even in diabetic patients. RESULTS: Phenol lumbar sympathectomy was performed on 373 patients, of whom 226 (60.6%) were diabetic. Over 24-120 months of follow-up, 219 patients (58.7%) experienced total relief from pain and healing of gangrenous ulcers, although the treatment was unsuccessful in 154 patients. A favorable result was marked in diabetic patients who had rest pain and in non-diabetic patients who had digital gangrene or digital ulcers. Age and sex did not affect the results but heavy smoking did. CONCLUSION: Phenol sympathectomy should be considered as an alternative to surgical sympathectomy. Furthermore, the technique may be a precursor to and even an alternative to amputation in patients who have diabetes and advanced arteriosclerosis of the lower limb.