Lumbar Sympathectomy with RFA and Chemical Neurolysis for Diabetic Ischemic Limb Pain

Abstract Background: Ischemic limb disease in patients with diabetes primarily affects the lower limbs. This condition can lead to debilitating symptoms such as pain, ulceration, and impaired healing, often resulting in amputations. Treatment options include pharmacological management, glycemic control, lumbar sympathectomy, endovascular therapy, and revascularization. A minimally invasive approach, combining lumbar sympathectomy with radiofrequency ablation (RFA) and chemical neurolysis (CN), is being explored for its efficacy in alleviating ischemic limb pain. Objective: The study aimed to evaluate the effectiveness of lumbar sympathectomy in diabetic patients with ischemic limb pain. Methodology: This randomized clinical trial, conducted at BIRDEM General Hospital, involved 52 diabetic participants diagnosed with ischemic limb pain. Participants were randomly assigned to two groups: The control Group (A) received conservative treatment, while the experimental Group (B) underwent RFA with CN in addition to conservative care. Key metrics, including rest pain (Visual Analog Scale [VAS]), skin temperature and capillary refill time (CRT), were assessed at baseline and at intervals up to 3 months posttreatment. Results: Demographic characteristics were comparable between the two groups. Notably, Group B exhibited a significant reduction in rest pain immediately after the procedure and at subsequent follow-ups ( P < 0.001), with a mean VAS of 0.8 at 3 months. Improvements in CRT and skin temperature were also significant in Group B ( P < 0.001), with an average temperature increase of 2°C. Conclusion: RFA combined with CN of the lumbar sympathetic ganglion is a promising therapeutic option for managing lower limb ischemic pain in diabetic patients.