Image-guided chemical or thermal neurolysis represents an effective and safe procedure to provide a therapeutic option for patients with vasogenic diseases of the autonomic nervous system in whom conventional therapies have failed. The procedure can be performed under either MR or CT guidance. The most common indication for neurolysis of lumbar sympathetic fibers is peripheral artery disease (PAD) of the lower extremity.. Nevertheless, other indications such as complex regional pain syndrome (CRPS), Raynaud’s syndrome, or diabetic neuropathy (DNP) are also effectively treated by percutaneous neurolysis. If the effect of the initial neurolysis wears off, a repetition of the treatment is an effective option.