Effect of lumbar sympathectomy on the lower extremity.

1. Lumbar sympathectomy creates a state of vasodilatation equivalent to physiological vasodilatation of daily living; however, after sympathectomy, vasodilatation is permanent and irreversible. 2. This vasodilatation is characterized at rest by a preferred distribution of blood to the skin and to subcutaneous cellular tissue of the lower extremity, foot and toes. 3. This vasodilatation, although permanent, does not interfere with increased output to muscles at work. They benefit by a particular mechanism of metabolic vasodilatation (Fig. 6). 4. Lumbar sympathectomy has a beneficial effect on the collateral compensatory circulation of an obliterated large artery. This effect is induced by suppression of the peripheral resistance, and thus, by increasing the pressure gradient. 5. The vasodilatation obtained by intravenous injection of pentothal is qualitatively the same as that which follows a lumbar sympathectomy. The test with pentothal, because of this action, is an excellent method for prognosis and control of lumbar sympathectomy effects.

[Indications for aorto and iliofemoral bridges]. / Indication des pontages aorto et ilio-fémoraux

As distinct from aneurysmal and embolic lesions, chronic aorto-iliac obliterating lesions often involve a difficult choice of therapy: whether to be optimistic and treat the lesions medically because they are discrete and not dangerous; to amputate because the lesions are too advanced; to carry out careful consservative surgery, hyperaemizing surgery, or alternatively more radical surgery involving deobliteration or bridging. The clinical picture (general condition, social context, clinical stage, unilateral or bilateral lesions) will influence the decision, but the last word depends on the aorto-arteriographic picture and on the result of vasomotor tests. Arterial reconstruction by bridging using a Dacron prosthesis is not advised except in a minority of cases.