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Poster displayed – Chronic pain management
P240 Optimizing lumbar sympathectomy for vascular disease: infrared monitoring to identify optimal candidates
  1. Ladislav Kočan1,
  2. Marek Hudák2,
  3. Viktória Rajťúková3 and
  4. Róbert Rapčan4
  1. 1Clinic of Anaesthesiology and Intensive Care Medicine, East Slovak Institute of Cardiovascular Disease, Košice, Slovakia
  2. 2Department of Angiology, East Slovak Institute of Cardiovascular Disease, Košice, Slovakia
  3. 3Department of Biomedical Engineering and Measurement, Faculty of Mechanical Engineering, Technical University of Kosice, Košice, Slovakia
  4. 4Interventional Pain Department, EuroPainClinics, Bardejov, Slovakia

Abstract

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Background and Aims Chronic limb-threatening ischemia (CLTI), the advanced stage of lower extremity artery disease (LEAD), is associated with high mortality, limb loss, pain, and diminished health-related quality of life (HRQL). Despite advancements in endovascular treatments, significant amputation rates (12-20% within the first year post-revascularization) persist due to ongoing microvascular dysfunction that impairs blood flow and oxygen delivery. Lumbar sympathectomy (LS), a minimally invasive procedure disrupting sympathetic nerve pathways, has shown potential to reduce peripheral resistance and enhance microvascular circulation, though its role in CLTI treatment is not well understood.

Methods Our study (approval number 4/2023/VUSCH/EK, clinicaltrials.gov NCT06111599) evaluates the efficacy of lumbar sympathetic block (LSB) in three CLTI patients by assessing thermal changes and pain levels. We focused on comparing skin areas on the legs and feet, considering their innervation by peripheral nerves, which are related to the localization of angiosomes. These areas include dermatomes innervated by the saphenous nerve (L3,4), tibial nerve branches (medial plantar nerve L4,5; lateral plantar nerve S1,2; medial calcaneal branches S1,2), sural nerve (S1,2), and superficial peroneal nerve (L4-S1), corresponding to the posterior tibial, peroneal, and anterior tibial artery angiosomes, respectively.

Results Post-LSB, patients showed increased limb temperatures and reduced pain, indicating improved perfusion and symptom relief.

Conclusions These findings suggest that LSB could benefit CLTI patients, particularly those ineligible for endovascular procedures. Further research through a randomized controlled trial is needed to confirm LSB’s therapeutic potential and explore advanced techniques like cryoablation and radiofrequency ablation for prolonged denervation effects.

Abstract P240 Figure 1
Abstract P240 Figure 1

Lumbar sympathetic block - approach

Abstract P240 Figure 2
Abstract P240 Figure 2

Foot dermatomes

Abstract P240 Figure 3
Abstract P240 Figure 3

Comparison of thermal changes

  • Lumbar Sympathectomy
  • Chronic limb-threatening ischemia

https://doi.org/10.1136/rapm-2024-ESRA.315

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