Lumbar Sympathetic Radiofrequency Ablation for Peripheral Arterial Disease: A Short-Term, Self-Controlled, Retrospective Pilot Study of 16 Patients

Purpose: To report the short-term outcomes of lumbar sympathetic radiofrequency ablation (LSRA) in patients with peripheral arterial disease (PAD) who were refractory to conservative management or unsuitable for revascularization, and to generate preliminary evidence to inform the design of future prospective investigations. Patients and Methods: A retrospective, self-controlled analysis was conducted on consecutive patients with PAD who underwent LSRA at our institution between July 2025 and March 2026. Pain intensity (Faces Pain Scale–Revised, FPS-R), toe skin temperature, and perfusion index (PI) were measured preoperatively and on postoperative day 7. Complications were documented. Normality of between-condition differences was assessed using the Shapiro–Wilk test. Wilcoxon signed-rank tests were used as the primary analysis for non-normally distributed variables, with paired t-tests as sensitivity analysis. Effect sizes (Cohen’s d for paired samples) with 95% confidence intervals were calculated. Results: Sixteen patients were included, comprising 14 cases of atherosclerotic occlusive disease and 2 cases of thromboangiitis obliterans. At postoperative day 7, FPS-R scores decreased from 5.88± 1.36 to 3.75± 1.24 (V=91, p=0.001; Hedges’ g=1.48, 95% CI 0.77– 2.17, large effect), toe skin temperature increased from 35.06± 1.04 °C to 35.95± 0.78 °C (t=− 5.06, p=0.00014; Hedges’ g=− 1.20, 95% CI − 1.82 to − 0.56, large effect), and PI increased from 2.92± 1.71 to 3.94± 1.71 (V=0, p=0.0005; Hedges’ g=− 2.02, 95% CI − 2.87 to − 1.16, large effect). One patient (6.25%) experienced lumbar artery injury requiring embolization, with successful resolution; no other major complications were observed. Conclusion: In this preliminary, short-term, retrospective pilot study of carefully selected PAD patients, LSRA was associated with improvements in pain, toe skin temperature, and perfusion index at postoperative day 7. These findings require validation in prospective, controlled trials with longer follow-up. Keywords: lumbar sympathetic radiofrequency ablation, peripheral arterial disease, pilot study, pain management, microcirculation