Sympathectomy may relieve rest pain by dilating vessels in the skin and so, encouraging cutaneous blood flow. The technique may be performed by surgical excision of part of the lumbar sympathetic chain, or by translumbar injection of 6% aqueous phenol.
Sympathectomy redistributes the blood flow in the leg rather than increasing it's total amount. Consequently, it is most beneficial when the ischaemia is superficial. It is of little value in patients with intermittent claudication in whom symptoms are due to poor blood supply to muscle.
About 15% of people treated by sympathectomy obtain sufficient relief from their symptoms to avoid reconstructive surgery or amputation. The technique may be helpful in healing ulcers where ischaemia is present with some other factor such as chronic venous insufficiency.
NICE state that "..do not offer chemical sympathectomy to people with critical limb ischaemic pain, except in the context of a clinical trial.."
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