Over a 13 year period, 544 chemical lumbar sympathetic blocks with phenol in 489 patients were performed by the author with the aid of X-ray image intensification. There was objective and subjective improvement in the signs and symptoms of limb ischaemia in 72%, judged by relief of rest pain, improvement in skin blood flow or healing of ischaemic ulcers. Of patients treated in the years 1990-1993, 44% had suffered either death or major amputation within two years of their treatment. Three serious and probably avoidable complications are described.