Original communication| Volume 37, ISSUE 4, P567-575, April 1955

The effect of lumbar sympathectomy on the collateral arterial circulation

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      Within three to four weeks after superficial femoral artery ligation in the cat there is a considerable increase in the size of the largest collateral vessel present. Lumbar sympathectomy comparable to that usually performed in man for peripheral arterial disease does not augment this increase in size within seventy-five days, the longest any animal was studied.
      Lumbar sympathectomy does dilate the arterial vessels of the feet, at least early in arteriosclerosis obliterans. The eventual loss of the limb, however, is probably determined by the state of the main artery and its collaterals rather than by the existing degree of dilatation of the vessels of the feet.
      In spite of this evidence in the cat it may be that lumbar sympathectomy as now performed or a sympathectomy that also denervates the upper thigh vessels and the bifurcation of the abdominal aorta might affect the collateral vessels favorably and so prolong the life of the limb in progressive occlusive arterial disease in man. The need for controlled studies on this point is long overdue.
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        • Coller F.A.
        • Campbell K.N.
        • Harris B.M.
        • Berry R.E.L.
        The Early Results of Sympathectomy in Far-advanced Arteriosclerotic Peripheral Vascular Disease.
        Surgery. 1949; 26: 30
        • DeBakey M.E.
        • Creech O.
        • Woodhall J.P.
        Evaluation of Sympathectomy in Arteriosclerotic Peripheral Vascular Disease.
        J. A. M. A. 1950; 144: 1227
        • Edwards E.A.
        • Crane C.
        Lumbar Sympathectomy for Arteriosclerosis of Lower Extremities.
        New England J. Med. 1951; 244: 199
        • Elkin D.C.
        • Cooper Jr., F.W.
        • Rohrer R.H.
        • Miller Jr., W.B.
        • Shea Jr., D.C.
        • Dennis E.W.
        The Study of Peripheral Vascular Diseases With Radioactive Isotopes—Part I.
        Surg., Gynec. & Obst. 1948; 87: 1
        • Rapaport S.I.
        • Hyman C.
        • Morton M.E.
        Tissue Clearance as a Measure of Nutritive Blood Flow and the Effect of Lumbar Sympathetic Block Upon Such Measures in Calf Muscle.
        Circulation. 1952; 5: 594
        • Montgomery H.
        • Horwitz O.
        Oxygen Tension of Tissues by the Polarographic Method. I. Introduction: Oxygen Tension, and Blood Flow of the Skin of Human Extremities.
        J. Clin. Invest. 1950; 29: 1120
        • Horwitz O.
        • Pierce G.
        • Montgomery H.
        Oxygen Tension of Tissues by the Polarographic Method. III. The Effect of Local Heat on Oxygen Tension of the Skin of Extremities.
        Circulation. 1951; 4: 111
        • Gessler H.
        Ueber die Gewebsatmung bie der Vasomotorischem Reaktion.
        Arch. exper. Path. u. Pharmakol. 1922; 92: 273
        • Atlas L.N.
        Lumbar Sympathectomy in the Treatment of Peripheral Arteriosclerotic Disease. II. Gangrene Following Operation in Unproperly Selected Cases.
        Am. Heart J. 1942; 23: 493
        • Freeman N.E.
        • Leeds F.H.
        • Gardner R.E.
        Sympathectomy for Obliterative Arterial Disease: Indications and Contraindications.
        Ann. Surg. 1947; 126: 873
        • Wylie E.J.
        Thromboendarterectomy for Arteriosclerotic Thrombosis of Major Arteries.
        Surgery. 1952; 32: 275
        • Mulvihill D.A.
        • Harvey S.C.
        The Mechanism of the Development of Collateral Circulation.
        New England J. Med. 1931; 204: 1032
        • Theis F.V.
        Effect of Sympathetic Neurectomy on the Collateral Arteriole Circulation of the Extremities.
        Surg., Gynee. & Obst. 1933; 57: 737
        • Atlas L.N.
        Lumbar Sympathectomy in the Treatment of Selected Cases of Peripheral Arteriosclerotic Disease.
        Am. Heart J. 1941; 22: 75
        • Flasher J.
        Some Vascular Considerations in the Treatment of Arteriosclerosis Obliterans.
        Angiology. 1952; 3: 53
        • Flasher J.
        • White A.E.
        • Drury D.R.
        Sympathetic Denervation in the Treatment of Acute Arterial Occlusion.
        Circulation. 1954; 9: 238
        • Langley J.N.
        The Arrangement of the Sympathetic Nervous System Based Chiefly on Observations Upon Pilomotor Nerves.
        J. Physiol. 1894; 15: 176
        • Stromstein F.A.
        Davison's Mammalian Anatomy.
        in: ed. 7. The Blakiston Company, Philadelphia1947: 298
        • Lowenberg R.I.
        • Morton D.E.
        The Anatomic and Surgical Significance of the Lumbar Sympathetic Nervous System.
        Ann. Surg. 1951; 133: 525
        • Flasher J.
        • Drury D.R.
        • Gordon D.
        The Effect of Physiologic Variables on the Diameter of Small and Large Arterial Vessels.
        Angiology. 1951; 2: 302
        • Gordon D.
        • Flasher J.
        • Drury D.R.
        The Size of the Largest Arteriovenous Vessels in Various Organs.
        Am. J. Physiol. 1953; 173: 275
        • Reboul H.
        • Laubry P.
        Endarteriectomy in the Treatment of Chronic Endarteritis Obliterans of the Limbs and Abdominal Aorta.
        in: ed. 3. Proc. Roy. Soc. Med. 43. 1950: 547
        • Freeman N.E.
        • Gilfillan R.S.
        Regional Heparinization After Thromboendarterectomy in the Treatment of Obliterative Arterial Disease.
        Surgery. 1952; 31: 115
        • Scott W.J.M.
        • Morton J.J.
        Sympathetic Activity in Certain Diseases Especially Those of the Peripheral Circulation.
        Arch. Int. Med. 1931; 48: 1065
        • Smithwick R.H.
        Surgical Intervention on the Sympathetic Nervous System for Peripheral Vascular Disease.
        Arch. Surg. 1940; 40: 286
        • Trimble I.R.
        • Cheney W.S.
        • Moses W.R.
        The Operative Attack on Organic Peripheral Vascular Disease.
        Surgery. 1944; 15: 655
        • Lee R.M.
        • Krauskoph F.F.
        Evaluation of Lumbar Sympathectomy.
        South. M. J. 1949; 42: 864
        • Wilkins R.W.
        • Eichna L.W.
        Blood Flow to the Forearm and Calf.
        Bull. Johns Hopkins Hosp. 1941; 68: 425
        • Allen E.V.
        • Barker N.W.
        • Hines Jr., E.A.
        Peripheral Vascular Diseases.
        in: W. B. Saunders Company, Philadelphia1946: 395
        • Cannon W.B.
        • Newton H.F.
        • Bright E.M.
        • Menkin V.
        • Moore R.M.
        Some Aspects of the Physiology of Animals Surviving Complete Exclusion of Sympathetic Nerve Impulse.
        Am. J. Physiol. 1929; 89: 84
        • White J.C.
        Progress in Surgery of the Autonomic Nervous System, 1940–1942.
        Surgery. 1944; 15: 491
        • Roth G.M.
        The Distribution of Anhidrosis Following Interruption of Various Sympathetic Pathways in Man.
        Surgery. 1937; 2: 343
        • Thompson J.E.
        • Brace U.A.
        • Smithwick R.H.
        Patterns of Electrical Skin Resistance Following Sympathectomy.
        Arch. Surg. 1950; 60: 431