Background Management options for patients with chronic limb-threatening ischaemia (CLTI) that do not undergo revascularisation remain limited, particularly when major intervention is not feasible or is being deferred. Chemical lumbar sympathectomy (CLS) is used in some centres as an adjunct for ischaemic pain, but contemporary outcome data are sparse. This study evaluated short-term symptomatic response and limb outcomes following CLS in a tertiary referral practice. Methods A retrospective single-centre cohort study was performed of patients undergoing CLS between 2015 and 2025. Patients treated for peripheral arterial disease/CLTI were identified from institutional records. Baseline demographic, clinical and procedural data were extracted from the electronic medical record. Outcomes included early subjective pain response, procedure-related complications, minor amputation, major amputation and in-hospital death. Exploratory analyses assessed associations between baseline characteristics and pain response. Results Sixty limbs underwent CLS during the study period; 47 procedures were performed for peripheral arterial disease. Mean age was 73 years and 50% of patients were male. Early pain reduction was documented in 25/46 evaluable cases (54.3%). Reintervention occurred in 11 patients (18.3%), minor amputation in 7 (11.7%), major amputation in 8 (13.3%), and death during the index admission in 4 (6.7%). Procedure-related major complications were rare, with one patient (1.7%) sustaining acute spinal syndrome with associated bowel/bladder dysfunction. Conclusion In a contemporary single-centre experience, CLS was used as an adjunct in a high-risk cohort with limb ischaemia that did not undergo revascularisation. CLS was associated with early pain improvement in approximately half of evaluable patients, with a low rate of serious procedural complications.