Of 66 patients exhibiting Raynaud's phenomenon who have been followed from 1 to 25 years, 20 exhibited peripheral vascular disease, 35 were diagnosed as having collagen disease, 7 showed evidence of vasomotor hyperactivity, and 4 showed abnormal clumping of red blood cells or precipitation of globulin. Only 18 patients were subjected to bilateral dorsal sympathectomy. The failure rate is not so much due to the recurrence of sympathetic activity, but to case selection. Many patients have been erroneously subjected to sympathectomy, only to exhibit typical full-blown symptoms of scleroderma or lupus later. Results of the operations done in the presence of peripheral vascular disease, or because of a nervous discharge from the diencephalon, have been excellent except for 2 technical failures.
Owing principally to the investigations of Hering (1) and Heymans et al. (2), it is now well established that the carotid sinus and the aortic depressor nerve and its end organs are the chief nervous mechanisms for the regulation of the blood pressure. Considering their importance from a physiological viewpoint, it should not be surprising if surgical interference produced untoward effects. In animals, denervation of both carotid sinuses and section of both depressor nerves has been found by most investigators (1, 3, 4, 5) to cause a chronic hypertension and tachycardia, an increased lability of the blood pressure and pulse, and often various other disorders. Denervation of the carotid sinuses alone usually results in similar but only temporary changes (1, 4).For example, in 8 out of 10 dogs on whom Leriche et al. (6) had performed this operation, the blood pressure and pulse returned to normal in less than two months. However, in the 2 remaining animals there was still an elevation of the blood pressure of 20 and 40 mm. Hg respectively at the end of this time. Regarding other effects of this operation, especially the effect on postural vascular reflexes, there are very few data in the literature. Hering (1) states that, in dogs, there occurs a greater fall in blood pressure on assuming the standing position than in normal animals. Green and his coworkers (7) noted fainting attacks in 2 of their dogs who had bilaterally denervated carotid sinuses. These attacks may have been on a postural basis.In man, unilateral denervation of the carotid sinus results in only temporary elevation of the blood pressure and pulse, and, as far as is known, no change in the postural vascular reflexes (6,8).Bilateral carotid sinus denervation in man has not previously been reported in this country. In the European literature there are several reports, but the published data are very meager. Lauwers (9) found no serious effects in 9 cases. He includes no actual figures for blood pressures or pulse rates.Danielopolu (10) merely reports that the operation has been done and that no hypertension resulted. Five cases were operated upon by Leriche et al. (6) who state that no marked permanent variations in blood pressure or pulse rate occurred. However, figures are given for only 3 of the cases. In one of these the pressure returned to the preoperative level the day of operation; in another there was a hypertension 3 days postoperatively (further observations were not recorded); and in the third case the blood pressure was still elevated at the end of 4 months from a preoperative level of 140/70 to 165/85. In none of the above cases were observations on the effect of posture on the blood pressure recorded.From this review of the literature, it is apparent that our knowledge of the late effects of bilateral carotid sinus denervation in man is scanty and incomplete. Only resting blood pressures and pulse values have been determined, and then only in a few cases. We were fortunate in having available 2 patients on whom one of us (Geza de Ta...
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