Evolution of Concepts Regarding Sympathectomy Sympathectomy for occlusive vascular disease has had a hard time. The operation having originally been proposed for spastic paralysis by Hunter and Royle, Adson,1 in this country, and Diez,2 in, Rio de Janeiro, promptly recognized the warm dry skin following sympathetic denervation and advocated this operation for spastic vascular disorders and intractable hyperhidrosis. Since the postphlebitic syndrome often showed vasospastic phenomena, a number of clinics, notably the one at Tulane,3 added sympathectomy for the relief of the cold, edematous extremity. The emphasis in the early years of sympathectomy was on "vasospasm," and only after Trimble's suggestion4 was arteriosclerosis included among the indications, an idea which our group heartedly endorsed.5 After Spurling6 reported the first cases, in 1930, causalgic pain was treated by sympathectomy with dramatic relief. Depending on the extent of the denervation and the duration of the disease,