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Thoracoscopic Sympathectomy for Symptomatic Arterial Obstruction of the Upper Extremities

Tiziano De Giacomo, MD, Erino A. Rendina, MD, Federico Venuta, MD, Domenico Lauri, MD, Edoardo S. Mercadante, MD, Marco Anile, MD, and Giorgio F. Coloni, MD.

Division of Thoracic Surgery and Division of Vascular Surgery, University of Rome "La Sapienza," Rome, Italy.

Severely symptomatic arterial insuffi-ciency of the hand and upper extremities requires ade-quate treatment. Medical therapy and local care are usually unsuccessful, and thoracic sympathectomy can represent an effective procedure to control pain, to help ulcer healing, and to prevent or delay amputation.

Methods: We performed 20 thoracoscopic sympathec-tomiesin 15 patients (13 men and 2 women) with upper extremity ischemia. Mean age was 47 years (range 21 to 72 years). All patients were thought to have organic block-age of digital arteries. The condition was unilateral in 10 patients and bilateral in 5. Primary diagnosis was digital arteriosclerosis in 8 patients, Buerger's disease in 4 pa-tients and the remaining 3 were drug abusers with severe ischemia due to accidental intraarterial injection of drugs. Eleven patients (73%) presented with terminal digital necrosis, gangrene, or ulceration of the fingers associated with severe pain. Four patients complained of coldness, pain, and some degree of soft tissue infection without permanent loss of tissue. 

Results: We performed 10 unilateral and five bilateral staged (mean interval was 3 months) thoracoscopic sym pathectomies. We had two minor complications and no mortality. Mean duration of postoperative chest drainage was 2.5 _ 0.4 days and mean postoperative hospital stay was 5.3 _ 0.5 days. Follow-up ranged from 3 to 71 months, with a mean of 33 months. All patients demon-strated clinical benefit after operation.

Conclusions: Thoracoscopic sympathectomy in patients with severe ischemia of upper limb extremities permits optimal symptomatic control and maximum tissue sal-vage. Because the procedure is minimally invasive, safe, and associated with a low rate of complications, it should be considered earlier the natural course of this disease. (Ann Thorac Surg 2002;74:885- 8)  2002 by The Society of Thoracic Surgeons.





