Two Year Results of the Treatment of Essential Hypertension by Celiac Ganglionectomy
In the treatment of essential hypertension we have performed 476 operations on the adrenal sympathetic system in 285 patients. These have included 325 celiac ganglionectomies in 199 patients. In the latter series 35 patients were operated upon two or more years ago. From the study of the results in these 35 cases we have drawn certain conclusions as to the indications for operation.
The calendar age has no effect upon the results of celiac ganglionectomy. It is the physiological, not the calendar age, that counts. What happens to the blood pressure as a patient grows older? It tends to rise secondary to advancing sclerosis. That progressive increase in the blood pressure cannot be cured, that is, there is a cardiovascular age, and that age may be established in younger individuals for there is a certain stage in hypertension in which there is an irreversible condition due to sclerosis alone. Wherever there is molecular injury and repair, as in scars and burns, which are subjected to pressure or irritation, the scar grows. By the same process when there is a certain amount of scar tissue or sclerosis in the vascular tree it will grow, just as does a scar in the esophagus, in the intestines, or a scar from a burn at the elbow. Such scars grow larger because of continuous molecular injury and repair.
In a case in which sclerosis is present the blood pressure may fall after celiac ganglionectomy, but the extent to which it will fall is limited. . .