Authors' results and conclusions: We found 103 references, finally we have included 8 articles about lumbar sympathectomy and 1 about medular stimulation. General quality of them has been low. Comparing lumbar sympathectomy and usual treatments we have not found differences in terms of mortality, amputations, and gravity of intermittent claudication in patients with II Fontaine stage. In patients with more advances stages of the disease we have found clinical improvements with lumbar sympathectomy, however, low quality of included studies implies that these results should be considered cautiously. Sympathecmoy compared to E1 postagladine did not show differences for this technique. Surgical sympathectomy compared to chemical sympathectomy better results were registered for the chemical one in terms of mortality and hospital stay. The review that assessed medular stimulation showed better results in treated patients by means of this technique compared to patients treated with conventional care (RR 0.74, CI 0.57-0.94). More patients reached Fontaine stage II, the size of the effect was 33% in terms of differences of proportions. The most frequent complications were re-interventions (12%), initial problems of implantation (8%) and infections (3%).

Authors' recommendations: Evidence on efficacy of lumbar sympathectomy, based on clinical trials and observational studies of low quality did not show differences between these two techniques and conventional care in patients in stage II. Some advantages have been shown with sympathectomy with patients in stages III and IV. Chemical sympathectomy offers better results than surgical one in terms of mortality and amputations, although these results were not statistically significative. Electrical medular stimulation reduces the risk of amputations compared to conventional treatment, it improves the clinical state of the patients and it alleviates the pain.

Project Status: Completed

URL for project: https://www.aetsa.org/publicacion/efectividad-de-dos-opciones-terapeuticas-en-arteriopatia-periferica-no-revascularizable-simpatectomia-lumbar-y-estimulacion-medular/

Year Published: 2009

URL for published report: https://www.aetsa.org/download/publicaciones/antiguas/AETSA_2008_6_Simpatectomia.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)