Comparison of the effect of lumbar sympathectomy in patients with or without vascular bypass surgery: A retrospective observational study.

BACKGROUND AND AIMS: Peripheral arterial disease (PAD) impairs blood flow to the extremities, leading to symptoms that impair quality of life (QOL). Lumbar sympathectomy (LS) has shown potential in symptom management, particularly in cases where medical therapy or vascular bypass surgery fails. However, limited evidence compares the efficacy of LS in patients with and without prior vascular bypass surgery. This study evaluates the differential impact of LS on pain relief, analgesic consumption, and QOL in these subgroups.

MATERIAL AND

METHODS

A retrospective observational study was conducted involving 34 PAD patients who underwent fluoroscopy-guided LS between September 2023 and June 2024. Patients without prior vascular bypass surgery (Group L, n = 17) and with prior vascular bypass surgery (Group LB, n = 17) were assessed for pain using the Visual Analog Scale (VAS), analgesic consumption with the Overall Benefit of Analgesic Score (OBAS), and QOL via World Health Organization Quality of Life Brief Version (WHOQOL-BREF). OBAS is a 7-item patient self-report instrument that combines pain severity, opioid side effects, and treatment satisfaction in the past 24 h. We examined the sum of all WHOQOL-BREF items as the prespecified QOL measure (26 items; higher scores = better QOL). The four domains (Physical, Psychological, Social Relationships, and Environment) were not examined individually in the primary analysis to prevent multiplicity and because of the small sample size; results at the domain level, if examined, were considered exploratory and are not inferentially contrasted. Analysis of data was performed with descriptive statistics, paired and independent t-tests, Welch's t-tests, standardized effect sizes (Hedges' g and Cohen's dz), and repeated-measures Analysis of Variance test analysis of variance (ANOVA) with Greenhouse-Geisser correction; statistical significance was at P < 0.05.

RESULTS

Both groups showed significant improvements in VAS, OBAS, and QOL (P < 0.001). Patients in Group L experienced better immediate pain relief (VAS at 24 h: 3.29 vs. 4.29, P = 0.001) and sustained OBAS benefits over three months (P < 0.05). QOL improvements were comparable between groups in the long term.

CONCLUSIONS

LS is effective in improving pain, reducing analgesic use, and enhancing QOL in PAD patients. Bypass-naïve patients demonstrated better immediate outcomes, suggesting tailored therapeutic benefits. Prospective studies are needed to confirm these findings.