A Novel Approach to Diabetes-Related Foot Ulcers/Disease: First Report of Bipolar Pulsed RF Lumbar Sympathectomy
Summary: This retrospective cohort of 31 DFU patients with critical limb ischemia ineligible for revascularization underwent bipolar pulsed radiofrequency (RF) lumbar sympathectomy, achieving 60% wound closure, significant pain reduction (VAS 7.2 to 2.1), and improved ABI (0.6 to 0.8). Performed under fluoroscopy, the procedure disrupts sympathetic nerves to enhance perfusion without surgery, with 80% limb salvage at 12 months. As first report, it offers a safe, minimally invasive adjunct for refractory DFUs, warranting RCTs.
Key Highlights:
- Cohort: 31 patients (mean age 62, 65% male); Wagner II-IV DFUs; ABI <0.7.
- Procedure: RF at L2-L3 under fluoroscopy; 80% sympathectomy success.
- Outcomes: 60% closure at 3 months; pain VAS drop 5.1; no major AEs.
- Follow-Up: 80% AFS at 12 months; improved transcutaneous O2.
- Authors: Iida O et al. (Nov 13, 2025).
Keywords: bipolar RF, lumbar sympathectomy, diabetes foot ulcers, perfusion, limb ischemia, O Iida, T Yokoi, M Kato