NEWER METHODS FOR SELECTION OF PATIENTS FOR LUMBAR SYMPATHECTOMY

The degree of vasodilatation achieved by various diagnostic methods (arterial occlusion, ganglionic block established by certain agents, lumbar sympathetic block, spinal anesthesia, and indirect heating) was studied by means of the pneumo-plethysmogram as well as through readings of skin temperature and skin resistance. The data obtained were interpreted as to their value in determining the type of patient with vascular disease for whom lumbar sympathectomy would be of noticeable benefit. Arterial occlusion proved itself a rapid and simple method which in most patients produced satisfactory results. As a rule, lumbar sympathectomy was effective in patients who preoperatively had shown a positive response upon release of arterial occlusion. A negative response, that is, absence of significant increase in blood flow, does not necessarily indicate organic disease, and cannot be taken to mean that lumbar sympathectomy would always be ineffective. Ganglionic block, using 2.6 dimethyl piperidinium bromide or tetraethylammonium ion, was generally less reliable in indicating the probable results of sympathectomy than lumbar sympathetic block or indirect heating. Lumbar sympathetic block with procaine was followed by a greater increase in skin temperature and blood flow than spinal anesthesia, and permitted far more accurate conclusions as to the probable outcome of sympathectomy. Subsequent to indirect heating the plethysmogram showed characteristic differences depending on the degree of vascular disease present. From the effect of this simple, safe and painless method upon the relative blood flow to the toe it becomes possible to arrive at a comparatively accurate estimate of the clinical benefit to be expected from lumbar sympathectomy.