Lumbar sympathectomy and distal arteriovenous fistula as adjuncts to prevent arterial rethrombosis after thrombectomy: experimental study in dogs.

The role of lumbar sympathectomy and distal arteriovenous fistula (AVF) in preventing rethrombosis of femoral arteries with intimal injury and poor run-off was studied in 21 dogs. Femoral artery thrombosis was induced by endothelial lesion in all animals (phase 1) and 24 hours later the arterial flow was restored by thrombectomy. The dogs were then randomly allocated into 3 experimental groups: control, sympathectomy, and AVF (phase 2). Critical stenosis of the popliteal artery was then created by a partially occluding ligature in all animals in order to simulate poor run-off. After 24 hours the femoral arteries were studied for the presence of rethrombosis (phase 3). At the end of phase 2 and during phase 3, femoral pressure and flow, fluorescein circulation time and paw temperature were measured, and arteriography was done. Arterial rethrombosis was significantly prevented in the AVF group (6/7) when compared to the control group (2/7) or the sympathectomy group (1/7). These data suggest an effective action of an adjuvant AVF, but not of sympathectomy in preventing rethrombosis after thrombectomy in arteries with poor run-off.