Sympathicolysis is a procedure for temporary or long-term elimination of sympathetic innervation. It is used to improve blood circulation in the legs or arms. The sympathetic nervous system causes the balance of the autonomic system to lean towards narrowing of blood vessels, with elimination of its function resulting in

vasodilatation Vasodilation is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The process is the opposite of vasoconstriction, ...

. Completely blocked arteries are not opened again, but the collaterals are better supplied with blood. To improve the blood circulation to the upper extremities, an anesthetic block of the

stellate ganglion The stellate ganglion (or cervicothoracic ganglion) is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic (superior thoracic sympathetic) ganglion, which exists in 80% of people. Sometimes, the seco ...

is performed. Due to this blockage, in addition to vasodilatation, in the entire innervation area this leads to reduced sweating (

anhidrosis Hypohidrosis is a disorder in which a person exhibits diminished sweating in response to appropriate stimuli. In contrast with hyp''er''hidrosis, which is a socially troubling yet often benign condition, the consequences of untreated hypohidrosi ...

) and

Horner's syndrome Horner's syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. The signs and symptoms occur on the same side (ipsilateral) as it is a lesion o ...

. The latter is a sign of successful blockade. A temporary blockade of the stellate ganglion is performed for e.g. the treatment of advanced complex regional pain syndrome. Surgical elimination of the stellate ganglion (

sympathectomy A sympathectomy is an irreversible procedure during which at least one sympathetic ganglion is removed. One example is the lumbar sympathectomy, which is advised for occlusive arterial disease in which L2 and L3 ganglia along with intervening sym ...

) is a treatment of last resort for

Raynaud's disease Raynaud syndrome, also known as Raynaud's phenomenon, eponymously named after the physician Auguste Gabriel Maurice Raynaud, who first described it in his doctoral thesis in 1862, is a medical condition in which the spasm of small arteries cau ...

. The sympathetic plexus can also be blocked in other parts of the body. Lying on the major abdominal vessels sympathetic plexus may, for example, under local anesthesia guided by a CT scan it can be turned off by injection of concentrated alcohol (

interventional radiology Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bo ...

Procedure

In CT guided lumbar sympathicolysis, the site of neurolytic solution injection is chosen at the level of L2-L3 vertebra level. The needle should avoid the vertebral transverse process, ureter, pelvicalyceal system, and other major blood vessels. The target injection site would be anteromedial to the psoas muscle and dorsolateral to the abdominal aorta, where the sympathetic trunk would most likely be located. After the skin of the puncture site is cleaned, 2% lignocaine is injected into the to numb the skin and also the needle trajectory. Then a 22G China needle is inserted into the target site, which is bounded by the vertebral body, aorta, inferior vena cava, and psoas muscle. This region houses the lumbar sympathetic ganglion. Then, iodinated contrast medium (

iohexol Iohexol, sold under the trade name Omnipaque among others, is a contrast agent used for X-ray imaging. This includes when visualizing arteries, veins, ventricles of the brain, the urinary system, and joints, as well as during computed tomograp ...

) and lignociane is injected into the target site to check the position of the needle tip. Once the needle tip position is confirmed, a mixture of neurolytic solution (99.9% alcohol) and iodinated contrast medium (at a ratio of 10:1) is injected into the target site.

References

{{reflist Sympathetic nervous system