Original communication| Volume 87, ISSUE 2, P216-221, February 1980

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Predicting the success of a sympathectomy: A prospective study using discriminant function and multiple regression analysis

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      A prospective study of 72 limbs treated with phenol sympatholysis for inoperable peripheral arterial occlusive disease was carried out in order to determine which factor or combination of factors could most accurately be used to predict the success or the failure of the sympathetic interruption. Seven variables were recorded prior to phenol sympatholysis and the patients were followed up to 3 years in order to determine the degree of success or failure of the sympathectomy. The results of discriminant function analysis of these data showed that the most important variables in predicting the outcome were (1) the level of ankle systolic pressure, (2) the presence or absence of a neuropathy, and (3) the extent of the ischemic damage. The correct outcome was predicted in 87% of the cases. Using these three variables, multiple regression analysis was performed to construct a table showing the percentage chance of a successful outcome from a sympathectomy. The results show that a phenol sympathectomy is likely to be successful in the management of a patient with peripheral arterial occlusive disease if there is no evidence of a somatic (and hence autonomic) neuropathy, if the ankle systolic pressure is above 30 mm Hg, and if the tissue damage is not too extensive (i.e., only rest pain, night pain, or digital gangrene is present).
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        • Barcroft H
        • Swan HJC
        Sympathetic control of human blood vessels.
        in: Edward Arnold & Co, London1953: 6
        • Berry REL
        • Flotte CT
        • Coller FA
        A critical evaluation of lumbar sympathectomy for peripheral arteriosclerotic vascular disease.
        Surgery. 1955; 37: 115
        • Blain A
        • Zadeh AT
        • Teves ML
        • Bing RJ
        Lumbar sympathectomy for arteriosclerosis obliterans.
        Surgery. 1963; 53: 164
        • Cranley JJ
        Clinical grading of the severity of obliterative arterial disease of the lower extremities.
        Surgery. 1955; 38: 928
        • Cranley JJ
        Vascular surgery.
        in: ed 3. Peripheral arterial diseases. vol. 1. Harper & Row, Publishers, New York1972
        • Davis MT
        • Greene NM
        Polarographic studies of skin oxygen tension following sympathetic denervation.
        J Appl Physiol. 1959; 14: 961
        • Delaney J
        • Scarpino J
        Limb arteriovenous shunting following sympathetic denervation.
        Surgery. 1973; 73: 202
        • Delius W
        • Wallin G
        • Hagbarth K-E
        Role of sympathetic nerve impulses in regulation of peripheral circulation.
        Scand J Clin Lab Invest. 1951; 31: 47
        • Dornhorst AC
        • Sharpey-Schafer EP
        Collateral resistance in limbs with arterial obstruction: spontaneous changes and effects of sympathectomy.
        Clin Sci. 1951; 10: 371
        • Gillespie JA
        Late effects of lumbar sympathectomy on blood-flow in the foot in obliterative vascular disease.
        Lancet. 1960; 1: 891
        • Haimovici H
        Vascular surgery; principles and techniques.
        McGraw-Hill Book Co, New York1976
        • Haimovicci H
        • Steinman C
        • Karson IH
        Evaluation of lumbar sympathectomy. Advanced occlusive arterial disease.
        Arch Surg. 1964; 89: 1089
        • Haxton JA
        Chemical sympathectomy.
        Br Med J. 1949; 1: 1026
        • Hoffman DC
        • Jepson RP
        Muscle blood flow and sympathectomy.
        Surg Gynecol Obstet. 1968; 127: 12
        • Husni EA
        • Simeone FA
        Results of lumbar sympathectomy in peripheral vascular disease.
        Arch Surg. 1957; 75: 530
        • King RD
        • Kaiser GC
        • Lempke RE
        • Schumacker HB
        Evaluation of lumbar sympathetic denervation.
        Arch Surg. 1964; 88: 36
        • Kjellmer I
        On the competition between metabolic vasodilation and neurogenic vasoconstriction in skeletal muscle.
        Acta Physiol Scand. 1965; 63: 450
        • Knox WG
        The value of digital plethysmography in evaluating patients with peripheral arteriosclerosis for lumbar sympathectomy.
        Ann Surg. 1959; 149: 539
        • Lee RM
        • Krauskoph FF
        • Lilly GD
        Evaluation of lumbar sympathectomy.
        South Med J. 1949; 42: 864
        • Ludbrook J
        Collateral artery resistance in the human lower limb.
        J Surg Res. 1966; 6: 423
        • Moore WS
        • Hall AD
        Effects of lumbar sympathectomy on skin capillary blood flow in arterial occlusive disease.
        J Surg Res. 1966; 6: 423
        • Moorhouse JA
        • Carter SA
        • Doupe J
        Vascular responses in diabetic peripheral neuropathy.
        Br Med J. 1966; 1: 883
        • Rapaport SI
        • Saul A
        • Hyman C
        • Morton ME
        Tissue clearance as a measure of nutritive blood flow and the effect of lumbar sympathectomy block upon such measures in calf muscle.
        Circulation. 1968; 5: 594
        • Reid W
        • Watt JK
        • Gray TG
        Phenol injection of the sympathetic chain.
        Br J Surg. 1970; 57: 45
        • Remensnyder JP
        • Mitchell JH
        • Sarnoff SJ
        Functional sympatholysis during muscular activity.
        Circ Res. 1962; 11: 370
        • Rushmer RF
        Cardiovascular dynamics.
        ed 3. WB Saunders Co, Philadelphia1970
        • Rutherford RB
        • Valenta J
        Extremity blood flow and distribution: the effects of arterial occlusion, sympathectomy, and exercise.
        Surgery. 1971; 69: 332
        • Scarpino JJ
        • Delaney JP
        Lumbar sympathectomy and arteriovenous shunting.
        in: ed 4. Surg Forum. 22. 1971: 176
        • Shaw RS
        • Austen WG
        • Stipa S
        A ten-year study of the effect of lumbar sympathectomy of the peripheral circulation of patients with arteriosclerotic occlusive disease.
        Surg Gynecol Obstet. 1964; 119: 486
        • Shepherd JT
        Effects of sympathetic neurectomy.
        in: Physiology of the circulation in human limbs in health and disease. WB Saunders Co, Philadelphia1963: 73-87
        • Smithwick RH
        Lumbar sympathectomy in the treatment of obliterative vascular disease of the lower extremities.
        Surgery. 1957; 42: 415
        • Strand L
        Lumbar sympathectomy in the treatment of peripheral obliterative arterial disease.
        Acta Chir Scand. 1969; 135: 597
        • Strandness Jr, DE
        Peripheral arterial disease: A physiological approach.
        Little, Brown & Co, Boston1969
        • Strandness Jr, DE
        • Bell JW
        Critical evaluation of the results of lumbar sympathectomy.
        Ann Surg. 1964; 160: 1021
        • Strandness Jr, DE
        • Sumner DS
        Therapy of occlusive arterial disease.
        in: Hemodynamics for surgeons. Grune & Stratton, Inc, New York1975: 290-341
        • Szilagyi DE
        • Smith RF
        • Scerpella JR
        • Hoffman K
        Lumbar sympathectomy. Current role in the treatment of arteriosclerotic occlusive disease.
        Arch Surg. 1967; 95: 753
        • Taylor GW
        • Calo AR
        Atherosclerosis of arteries of lower limbs.
        Br Med J. 1962; 1: 507
        • Thulesius O
        • Gjores JE
        • Mandaus L
        Distal blood flow and blood pressure in vascular occlusion; influence of sympathetic nerves on collateral blood flow.
        Scand J Clin Lab Invest. 1973; 31: 53
        • Walker PM
        • Key JA
        • MacKay IM
        • Johnston KW
        Phenol sympathectomy for vascular occlusive disease.
        Surg Gynecol Obstet. 1978; 146: 741
        • Weissenhofer W
        • Schenk Jr, WG
        Effects of sympathectomy on blood flow through stenotic vessels during exercise: an experimental study of a canine model.
        Surgery. 1973; 74: 734
        • Wright CJ
        • Cousins MJ
        Blood flow distribution in the human leg following epidural sympathetic blockade.
        Arch Surg. 1972; 105: 334
        • Yao JST
        • Bergan JJ
        Predictability of vascular reactivity relative to sympathetic ablation.
        Arch Surg. 1973; 107: 676