Efficacy of CT-Guided Lumbar Chemical Sympathectomy for Pain Relief and Ulcer Healing in Patients with Thromboangiitis Obliterans and Peripheral Arterial Disease: Lumbar chemical sympathectomy for lower limb pain and ulcer management

Anu Sarah Easo; Jeyaseelan Nadarajah; Rajeev  Anand; Sujith Jos

doi:10.51168/sjhrafrica.v6i6.1562

Authors

Anu Sarah Easo MOSC Kolanchery
Jeyaseelan Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam, Kerala,India
Rajeev Al Azhar Medical College, Thodupuzha, Kerala, India
Sujith Malankara Orthodox Syrian medical college, Kolenchery. Ernakulam, Kerala, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1562

Keywords:

Lumbar chemical sympathectomy, thromboangiitis obliterans, peripheral arterial disease, ischemic pain, ulcer healing, CT-guided intervention

Abstract

Background: Lumbar chemical sympathectomy (LCS) is a minimally invasive procedure used to manage chronic lower limb pain and ischemic conditions, including thromboangiitis obliterans (TAO) and peripheral arterial disease (PAD). This study aimed to evaluate the efficacy of CT-guided LCS in pain reduction and ulcer healing among patients with chronic pain syndromes and TAO.

Methods: A retrospective observational study was undertaken at a medical college to evaluate the efficacy of LCS. Eighteen patients (mean age: 41.8 (± 16) years, 15 males, 3 females) with refractory ischemic pain or non-healing ulcers underwent single-level CT-guided LCS at L2/L3 using absolute alcohol and bupivacaine were selected. Pain intensity was assessed using the Visual Analog Scale (VAS) at baseline, 1 week, 2 months, and 6 months post-procedure. Ulcer healing was monitored clinically.

Results: The mean pre-procedure VAS score (8.2 ± 1.1) significantly decreased to 2.8 ± 1.5 postoperatively (p < 0.001), with further reductions at 1 week (1.94 ± 1.0) and 2 months (0.72 ± 0.98). No significant pain reduction was observed beyond the 2-month follow-up (p = 0.08). Among nine patients with ischemic ulcers, six demonstrated significant healing, including complete ulcer resolution in three cases. LCS was performed as a day-care procedure, with no major complications reported.

Conclusion: CT-guided LCS provides significant pain relief and ulcer healing in patients with TAO and PAD, offering a cost-effective alternative for those ineligible for surgical revascularization. However, further large-scale, long-term studies are warranted to establish its sustained efficacy and optimize patient selection.

Author Biographies

Jeyaseelan, Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam, Kerala,India

Associate Professor, Department of Radiology,

Rajeev , Al Azhar Medical College, Thodupuzha, Kerala, India

Professor, Department of Radiology

Sujith, Malankara Orthodox Syrian medical college, Kolenchery. Ernakulam, Kerala, India

Professor and Head, Department of Orthopedics

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