Preoperative selection of patients for lumbar sympathectomy by use of the Doppler index.

Yao and Bergan [8] have shown that an ankle systolic index of more than 0.25 is associated with a high rate of success from lumbar sympathectomy. This association has been borne out in our small series. We have also suggested that diseases that obviously compromise collateral circulation might be a relative contraindication to sympathectomy. Although incomplete, literature on collateral flow in relation to sympathectomy tends to confirm this idea. Consideration of such diseases as a contraindication to sympathectomy might further increase the success rate after sympathectomy. Regardless, ankle systolic index alone appears to be a reliable objective, non-invasive method of selecting patients with an increased chance of success from lumbar sympathectomy.