{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:09:10Z","timestamp":1787134150816,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The aim of this retrospective study was to evaluate the effect of lumbar sympathetic block (LSB) on pain scores, Fontaine Classification, and collateral perfusion status in patients with lower extremity peripheral artery disease (PAD), in whom revascularization is impossible. Material and Methods: Medical records of 21 patients with PAD who underwent LSB with a combination of local anesthetics, steroids, and patient follow-up forms containing six-month follow-ups between January 2020 and March 2021 were retrospectively reviewed. Numeric Rating Scale (NRS), Pain Detect Questionnaire (PDQ) scores, Fontaine Classification Stages, and collateral perfusion status (collateral diameter and\/or development of neovascularization) evaluated by arterial color Doppler Ultrasound (US) from the medical records and follow-up forms of the patients were reviewed. Results: NRS and PDQ scores were significantly lower, and regression of the Fontaine Classification Stages was significantly better after the procedure at the first, third, and sixth month than at the baseline values (p &lt; 0.001). Only four patients (19%) had collaterals before the procedure. An increase in the collateral diameter after LSB was noted in three out of four patients. Before the procedure, 17 patients had no prominent collateral. However, in thirteen of these patients, after LSB, neovascularization was detected during the six-month follow-up period (three patients in the first month, seven patients in the third month, and thirteen patients in the sixth month). The number of patients evolving neovascularization after LSB was found to be statistically significant at the third and sixth months compared to the initial examination (p &lt; 0.001). Conclusions: LSB with the use of local anesthetic and steroids in patients with lower extremity PAD not only led to lower NRS and PDQ scores, but also resulted in regressed Fontaine Classification Stages and better collateral perfusion status.<\/jats:p>","DOI":"10.3390\/medicina60050682","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T05:28:06Z","timestamp":1713850086000},"page":"682","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Retrospective Evaluation of the Effect of Lumbar Sympathetic Blockade on Pain Scores, Fontaine Classification, and Collateral Perfusion Status in Patients with Lower Extremity Peripheral Arterial Disease"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0649-6962","authenticated-orcid":false,"given":"Celalet","family":"Keser-Pehlivan","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Yuregir State Hospital, Adana 01240, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2527-3510","authenticated-orcid":false,"given":"Cagatay","family":"Kucukbingoz","sequence":"additional","affiliation":[{"name":"Department of Algology, Adana City Training and Research Hospital, Adana 01370, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5871-0695","authenticated-orcid":false,"given":"Umur Anil","family":"Pehlivan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Adana Dr. Turgut Noyan Application and Research Center, Faculty of Medicine, Baskent University, Adana 01240, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huseyin Tugsan","family":"Balli","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Cukurova University, Adana 01330, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0164-8258","authenticated-orcid":false,"given":"Hakki","family":"Unlugenc","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Cukurova University, Adana 01330, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayri Tevfik","family":"Ozbek","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Division of Algology, Faculty of Medicine, Cukurova University, Adana 01330, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1161\/CIR.0000000000001005","article-title":"Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement from the American Heart Association","volume":"144","author":"Criqui","year":"2021","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2040622319894466","DOI":"10.1177\/2040622319894466","article-title":"Pathophysiology of chronic peripheral ischemia: New perspectives","volume":"11","author":"Signorelli","year":"2020","journal-title":"Ther. Adv. Chronic Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.atherosclerosis.2018.05.033","article-title":"Update on peripheral artery disease: Epidemiology and evidence-based facts","volume":"275","author":"Shu","year":"2018","journal-title":"Atherosclerosis"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/HCR.0b013e31818c3b96","article-title":"Management of lower extremity peripheral arterial disease","volume":"28","author":"Gardner","year":"2008","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1152\/japplphysiol.00885.2013","article-title":"Physiology in medicine: Peripheral arterial disease","volume":"115","author":"Muller","year":"2013","journal-title":"J. Appl. Physiol."},{"key":"ref_6","unstructured":"Kulkarni, K., and Kulkarni, R. (2021). Novel Approaches in Regional Anesthesia & Pain Management, Open Access eBooks."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"20190070","DOI":"10.1590\/1677-5449.190070","article-title":"WIfI classification: The Society for Vascular Surgery lower extremity threatened limb classification system, a literature review","volume":"19","author":"Cerqueira","year":"2020","journal-title":"J. Vasc. Bras."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1111\/j.1468-1331.2010.02969.x","article-title":"EFNS guidelines on neuropathic pain assessment: Revised 2009","volume":"17","author":"Cruccu","year":"2010","journal-title":"Eur. J. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","article-title":"2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: The European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)","volume":"39","author":"Aboyans","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1177\/0300060516681398","article-title":"Change in pulse transit time in the lower extremity after lumbar sympathetic ganglion block: An early indicator of successful block","volume":"45","author":"Joo","year":"2017","journal-title":"J. Int. Med. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1177\/147323001003800131","article-title":"The cut-off rate of skin temperature changes to confirm successful lumbar sympathetic block","volume":"38","author":"Park","year":"2010","journal-title":"J. Int. Med. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1533-2500.2008.00177.x","article-title":"Sympathetic blocks: The evidence","volume":"8","author":"Day","year":"2008","journal-title":"Pain. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/j.1526-4637.2006.00148.x","article-title":"Pulsed radiofrequency: Current clinical and biological literature available","volume":"7","author":"Cahana","year":"2006","journal-title":"Pain Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1185\/030079906X132488","article-title":"painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain","volume":"22","author":"Freynhagen","year":"2006","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1016\/j.pain.2011.07.005","article-title":"Validity of four pain intensity rating scales","volume":"152","author":"Jensen","year":"2011","journal-title":"Pain"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.2147\/JPR.S134775","article-title":"Ganglion blocks as a treatment of pain: Current perspectives","volume":"10","author":"Gunduz","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4103\/ija.IJA_686_19","article-title":"Ultrasound lumbar sympathetic block: Out of plane approach with insulated stimulation needle-Case series of three patients","volume":"64","author":"Punj","year":"2020","journal-title":"Indian J. Anaesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1093\/pm\/pnab258","article-title":"To Assess Technical Feasibility of Ultrasound Lumbar Sympathetic Block with Electrical Stimulation Needle in Out of Plane Needle Orientation: A Prospective Interventional Study","volume":"23","author":"Marada","year":"2021","journal-title":"Pain Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.2214\/AJR.20.23089","article-title":"CT-Guided Lumbar Sympathectomy as a Last Option for Chronic Limb-Threatening Ischemia of the Lower Limbs: Evaluation of Technical Factors and Long-Term Outcomes","volume":"216","author":"Chahal","year":"2021","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_20","first-page":"152","article-title":"Percutaneous radio-frequency sympathetic block in peripheral circulatory disorders","volume":"30","author":"Dominkus","year":"1990","journal-title":"Vasa Suppl."},{"key":"ref_21","first-page":"1","article-title":"Evaluation of The Radiofrequency Ablation of Lumbar Sympathetic Ganglia In Lower Limb Ischemic Ulcers In Indian Population: Radiofrequency Ablation and Lower Limb Ischemic Ulcers","volume":"8","author":"Singh","year":"2021","journal-title":"Int. J. Med. Surg. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/0885-3924(94)00070-2","article-title":"Lumbar neurolytic sympathetic blockades provide immediate and long-lasting improvement of painless walking distance and muscle metabolism in patients with severe peripheral vascular disease","volume":"10","author":"Gleim","year":"1995","journal-title":"J. Pain Symptom Manag."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"55","DOI":"10.3344\/kjp.2010.23.1.55","article-title":"Sympathetic block for treating primary erythromelalgia","volume":"23","author":"Bang","year":"2010","journal-title":"Korean J. Pain"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kirksey, M.A., Haskins, S.C., Cheng, J., and Liu, S.S. (2015). Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0137312"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1093\/pm\/pnz142","article-title":"The Use of L2 and L3 Lumbar Sympathetic Blockade for Cancer-Related Pain, an Experience and Recommendation in the Oncologic Population","volume":"21","author":"Spiegel","year":"2020","journal-title":"Pain Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.1007\/s13300-020-00918-7","article-title":"Continuous Lumbar Sympathetic Blockade Enhances the Effect of Lumbar Sympatholysis on Refractory Diabetic Neuropathy: A Randomized Controlled Trial","volume":"11","author":"Sun","year":"2020","journal-title":"Diabetes Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1111\/papr.12958","article-title":"Lumbar Sympathetic Block for Intractable Lower-Limb Postherpetic Neuralgia: Report of Two Cases","volume":"21","author":"Ozturk","year":"2021","journal-title":"Pain Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1177\/1358863x08088616","article-title":"Gene and stem cell therapy in peripheral arterial occlusive disease","volume":"13","author":"Kalka","year":"2008","journal-title":"Vasc. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/ALN.0b013e3181aaea90","article-title":"Lumbar sympathetic blockade in children with complex regional pain syndromes: A double blind placebo-controlled crossover trial","volume":"111","author":"Meier","year":"2009","journal-title":"Anesthesiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1177\/0300060514532619","article-title":"Photoplethysmographic signals to predict the success of lumbar sympathetic blockade for lower extremity pain","volume":"42","author":"Park","year":"2014","journal-title":"J. Int. Med. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.2147\/JPR.S305543","article-title":"Clinical Application of Laser Speckle Flowgraphy to Assess Changes in Blood Flow to the Foot After a Lumbar Sympathetic Ganglion Block: A Case Report","volume":"14","author":"Kanda","year":"2021","journal-title":"J. Pain Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/j.ijcard.2012.03.103","article-title":"Cilostazol promotes angiogenesis after peripheral ischemia through a VEGF-dependent mechanism","volume":"167","author":"Biscetti","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_33","unstructured":"Alexander, C.E., De Jesus, O., and Varacallo, M. (2022). StatPearls, StatPearls Publishing."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/5\/682\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:32:31Z","timestamp":1760106751000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/5\/682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,23]]},"references-count":33,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["medicina60050682"],"URL":"https:\/\/doi.org\/10.3390\/medicina60050682","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,23]]}}}