The least splanchnic nerve (lowest splanchnic) arises from the 12th thoracic ganglion, passing through the diaphragm to synapse in the aorticorenal ganglion. It carries preganglionic sympathetic fibres to the renal plexus and is the most inferior of the three thoracic splanchnic nerves.
The least splanchnic nerve contributes to renal sympathetic tone and is involved in neurogenic hypertension pathways. Thoracic sympathectomy targeting the least splanchnic nerve has been explored for renal sympathetic denervation in resistant hypertension. It is at risk during lower thoracic paraspinal approaches and in right-sided procedures where it runs close to the azygos system.
Division of the least splanchnic nerve during lower thoracic approaches altering renal sympathetic tone, occasionally used deliberately in sympathectomy for renal hypertension management.
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