The use of laser Doppler flowmetry and transcutaneous oxygen measurements to evaluate the efficacy of sympathectomy in the treatment of arterial occlusive disease

Previous attempts to establish the efficacy of sympathectomy as a treatment for arterial occlusive disease in patients not amenable to vascular reconstruction have resulted in conflicting conclusions. The operation's effect on rest pain, ischemic lesions, and major amputations may not be valid and objective criteria for evaluating the effect of sympathectomy. The purpose of this investigation was to use laser Doppler flow analysis (LDF), transcutaneous oxygenation studies (TcPO₂), and other tools of the noninvasive vascular laboratory to evaluate objectively the effect of sympathectomy on blood flow in limbs with arterial occlusive disease. Twenty- two patients undergoing either unilateral sympathectomy or chemical sympathetic block had LDF, TcPO₂, extremity-brachial blood pressure indexes (EBI), and digital temperatures measured on the involved limb and the contralateral control limb before and after the procedure. Ten procedures were done for nonvascular indications on patients with no known vascular disease. Twelve were done for occlusive vascular disease. To correct for spontaneous day-to-day changes, results were recorded as a ratio of sympathectomized limb values to control limb values. The changes in the ratios as a result of the procedure were analyzed. In the normal group, significant improvement was seen in digital temperature, TcPO₂ with the electrode at room temperature, and digital LDF. In the abnormal group significant improvement occurred only in digital temperature, and there was no improvement in limb oxygenation or blood flow. Based on these results, we conclude that sympathectomy has little, if any, effect on blood flow in limbs with arterial occlusive disease.