Abstract
In a six-year period from February 1942 to February 1948, 473 patients (185 males and 288 females) were operated upon for essential hypertension and most of them were in advanced stages of hypertensive disease.
Patients were selected or rejected for operation on the basis of a set of rules drawn to guide clinical judgment.
The total of deaths in and out of the hospital over this period was 79 or a total mortality of 16 per cent. There were 38 inhospital deaths, or a mortality of 8 per cent. The causes of deaths occurring in the hospital were in the following order: cerebral accident, cardiac failure, and renal insufficiency. The out-of-the-hospital deaths were in the following order: cardiac failure, cerebral accident, and renal insufficiency.
Operations done early in the series followed the Smithwick procedure from T-9 through L-2, but later the minimal procedure was extended from T-3 through D-3, and in addition about 40 total sympathectomies which included the stellate ganglion were done. Results from the more extensive operation were better than those from the lesser procedure, but the mortality also was greater. Conclusion that complete or nearly complete sympathectomy is preferable to a less extensive procedure must await the collection of more data which can be used in weighing the respective end results against the mortality.
Thoracolumbar sympathectomy has a definite place in the treatment of hypertensive vascular disease, but its role in advanced cases is chiefly that of palliation.
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