Objective To investigate the effect of lumbar sympathectomy on collateral vessel formation and angiogenesis in a rat model of hindlimb ischemia. Methods A femoral artery ligation-induced hindlimb ischemia model was established in Sprague-Dawley rats, which were randomly divided into a control group and a sympathectomy group. The latter underwent bilateral lumbar sympathectomy. On postoperative day 14, collateral vessel formation in the ischemic limb was assessed by X-ray angiography and Micro-CT three-dimensional reconstruction, and vessel diameters were measured. Immunofluorescence double staining with α-SMA and CD31 was performed to visualize vascular structures, and Ki67 staining was used to evaluate the proliferative activity of vascular smooth muscle cells, thereby comprehensively analyzing vascular repair and regeneration. Blood perfusion in the plantar region was assessed on postoperative days 3, 7, and 14 using laser speckle imaging. On day 30, hematoxylin and eosin (H&E) staining was used to measure gastrocnemius fiber cross-sectional area, count CD31-positive microvessels, and detect VEGFA protein expression (day 3). On day 7, flow cytometry was performed to analyze the polarization ratio of M1/M2 macrophages in the adductor muscle group. Results Compared with the control group, the sympathectomy group exhibited a significantly larger mean collateral vessel diameter (0.52±0.09 mm vs. 0.38±0.07 mm, P<0.01) and increased numbers of α-SMA⁺/Ki67⁺ cells (5.38±0.87 vs. 2.22±0.64, P<0.01). Blood perfusion recovery rates on postoperative days 3, 7, and 14 were significantly improved (P<0.05). By day 30, gastrocnemius fiber cross-sectional area was markedly enlarged (1706±92 μm² vs. 1145±132 μm², P<0.001), CD31-positive microvessel counts were increased (171±19 vs. 93±8, P<0.001), and VEGFA expression was significantly upregulated (P<0.01). Moreover, the proportion of M2 macrophages was significantly elevated (28.7±3.0% vs. 17.8±2.2%, P<0.01), while the proportion of M1 macrophages showed no significant difference. Conclusions Lumbar sympathectomy effectively promotes collateral vessel growth and angiogenesis in ischemic rat hindlimbs. The underlying mechanism may involve the induction of macrophage polarization toward the M2 phenotype and upregulation of VEGFA expression.
Key words
Lumbar sympathectomy /
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Hindlimb ischemia /
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Collateral vessel growth /
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Angiogenesis /
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Macrophage polarization
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