The Role of Lumbar Sympathectomy in the Management of Buerger's Disease: A Systematic Review
Abstract
Introduction
Lumbar sympathectomy has been explored to manage Buerger's disease (BD) with varying success rates, but the results are often controversial. Despite the substantial morbidity associated with BD, there is a scarcity of comprehensive reviews on the topic. The current study is a systematic review of the efficacy of lumbar sympathectomy in the management of BD.
Methods
A meticulous systematic exploration was conducted across reputable databases and search platforms. The search strategy employed the following keywords:(lumbar sympathetic OR sympathectomy OR lumbar sympathetic block) AND (Buerger's disease OR Buerger OR thromboangiitis obliterans OR lower limb disease). Out of 42 identified studies, 16 were excluded during the initial screening phase. Following initial and full-text screenings, 10 studies remained eligible. The assessment of studies regarding the inclusion criteria was conducted independently by two authors, with a third author intervening to arbitrate any discrepancies.
Results
The demographic characteristics revealed that all participants were male, with a mean age of 38.9 years. Smoking prevalence among the cases was notably high (99%). Chemical sympathectomy was the predominant intervention, employed in 87.8% of cases, while surgical sympathectomy was utilized in only 12.2% of cases. Among the cases, 8.7% achieved complete resolution from the disease, while 91.3% reported partial relief.
Conclusion
Lumbar sympathectomy can be a viable treatment option for BD with fair outcomes. Nevertheless, smoking cessation remains the primary factor impeding disease progression and aggressiveness.
References
- Cacione DG, Moreno DH, Nakano LC, Baptista-Silva JC. Surgical sympathectomy for Buerger’s disease. JRSM open. 2017;8(8): doi:10.1177/2054270417717666
- Kothari R, Maharaj A, Tomar TS, Agarwal P, Sharma D. Percutaneous chemical lumbar sympathectomy for Buerger's disease: Results in 147 patients. Indian Journal of Vascular and Endovascular Surgery. 2017;4(4):185-90. doi:10.4103/ijves.ijves_23_17
- Jain K, Upadhyaya V, Varghese S. Chemical Lumbar Sympathectomy for Lower Limb Rest Pain Associated with Thromboangiitis Obliterans. Karnataka Anaesthesia Journal. 2015 1(3):157-9. doi:10.4103/2394-6954.173528
- O’Connor KJ, Grady JF, Moore CJ, Axe TM, Shumaker JM. Hallux amputation in combination with a lumbar sympathectomy for treatment of a non-healing ulceration in a patient with Buerger's disease. The Journal of foot and ankle surgery. 1996;35(4):339-43. doi:10.1016/S1067-2516(96)80084-6
- Usmani H, Hasan M, Alam MR, Harris SH, Mansoor T, Quadir A. Effect of preamputation lumbar sympathectomy on stump pain of lower limbs in patients of thromboangitis obliterans (Buerger′ s disease). Indian Journal of Pain. 2016;30(2):132-7. doi:10.4103/0970-5333.186471
- Bhattacharya D, Mukhopadhyay S, Hazra A. Fluoroscopy-guided lumbar sympathetic block with bupivacaine and depot methyl prednisolone for pain relief in Buerger's Disease—Our experience. Journal on Musculoskeletal Ultrasound in Pain Medicine. 2015;1(2):90-4. doi:10.5005/jp-journals-10046-0019
- Singh R, Shukla A, Kang LS, Verma AP. Chemical lumbar sympathetic plexus block in Buerger′ s disease: Current scenario. Indian Journal of Pain. 2014;28(1):24-8. doi:10.4103/0970-5333.128888
- Reddipogu JS, Sen I, Jeyaseelan L, Keshava SN, Stephen E, Agarwal S. Assessment of preprocedure difference in the supine and dependent transcutaneous tissue oxygenation to prognosticate pain relief, following chemical lumbar sympathectomy for critical limb ischemia in thromboangiitis obliterans. Indian Journal of Vascular and Endovascular Surgery. 2018;5(3):154-9. doi:10.4103/ijves.ijves_24_18
- Muhialdeen AS, Ahmed JO, Baba HO, Abdullah IY, Hassan HA, Najar KA, et al. Kscien's List; A New Strategy to Discourage Predatory Journals and Publishers (Second Version). Barw Med J.2023; 1 (1): 1 3. doi:10.58742/BMJ.V1I1.14
- Chander J, Singh L, Lal P, Jain A, Lal P, Ramteke V. Retroperitoneoscopic lumbar sympathectomy for buerger's disease: a novel technique. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2004;8(3):291-96. DOI: N/A
- Talwar S, Prasad P. Single-stage lumbar sympathectomy and omentopexy: a new surgical approach towards patients with Buerger's disease. Tropical doctor. 2001;31(2):73-5. doi:10.1177/004947550103100205
- Watarida S, Shiraishi S, Fujimura M, Hirano M, Nishi T, Imura M, et al. Laparoscopic lumbar sympathectomy for lower-limb disease. Surgical Endoscopy And Other Interventional Techniques. 2002; 16:500-3. doi:10.1007/s00464-001-8206-7
- Messinger WJ, Goodman EN, White JC. Treatment of thromboangiitis obliterans: Two-year follow-up after sympathectomy. The American Journal of Medicine. 1949;6(2):168-76. doi:10.1016/0002-9343(49)90015-7
- Fabregat G, Villanueva VL, Asensio JM, De Andrés J, Lopez D. Spinal cord stimulation for the treatment of Buerger disease: a report on 3 cases. The Clinical journal of pain. 2011;27(9):819-23. doi:10.1097/AJP.0b013e31821d8eff
- Khanna AK, Hakim MZ. The Management of Ischemic Limb in Thromboangiitis Obliterans (Buerger’s Disease). Indian Journal of Surgery. 2021;83(Suppl 4):836-44. doi:10.1007/s12262-021-02748-8
- Sasaki S, Sakuma M, Yasuda K. Current status of thromboangiitis obliterans (Buerger’s disease) in Japan. International journal of cardiology. 2000;75:S175-81. doi:10.1016/S0167-5273(00)00190-X
- Manfredini R, Boari B, Gallerani M, La Cecilia O, De Toma D, Galeotti R, et al. Thromboangiitis obliterans (Buerger disease) in a female mild smoker treated with spinal cord stimulation. The American journal of the medical sciences. 2004;327(6):365-8. doi:10.1097/00000441-200406000-00014
- Mashiah A, Soroker D, Pasik S, Mashiah T. Phenol lumbar sympathetic block in diabetic lower limb ischemia. European Journal of Cardiovascular Prevention & Rehabilitation. 1995;2(5):467-9. doi:10.1177/174182679500200512
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