BACKGROUND: A non-randomized, uncontrolled study was undertaken with a retrospective medical record review to evaluate the effect of pain relief of chemical lumbar sympathectomy in patients with peripheral vascular occlusive disease. This was conducted to assess whether the long term outcome of ischemic limbs could be changed and to identify predictable medical factors of patients who would be helped by this procedure. METHODS: A total of 47 patients with Buerger's disease (n = 20) and arteriosclerosis obliterans (n = 17) referred by vascular surgery for the management of ischemic pain were enrolled. All other conservative and surgical management efforts had already failed and were not indicated. The following were evaluated before and after the neurolytic lumbar sympathetic blocks: the stages of disease by Fontaine classification, main sites and numbers of occlusion, pain scores before and after the procedure, physical findings, amputation sites, and medications as well as amounts given and other risk factors. RESULTS: Buerger's disease tends to progress rapidly and aggressively. It is more painful than arteriosclerosis obliterans and is peripherally involved, with higher incidences of complications. Chemical sympathectomy has significant pain relief effects in both groups. Differences in long term outcome measured by amputation could not be found in both groups. No significant risk factors could be identified. No side effects were reported in both groups. CONCLUSIONS: Chemical lumbar sympathectomy has a good analgesic effect for pain in walking. This, however showed no long-term limb-saving effect.