Clinical results of lumbar sympathectomy

Lumbar sympathectomy appears to be effective in relieving rest pain, particularly when the ankle : brachial systolic pressure ratio (ABR) is relatively high, i.e., greater than 0.35. The ABR seems to have less predictive value when advanced skin changes are present, and in such cases the extent of ischemic necrosis is probably the major determinant of outcome. A low, or even unrecordable ABR, does not remove all hope of a successful outcome. However, it makes success less likely and can be used as a guide in determining the risk : benefit ratio for individual patients.