Extended Periarterial Sympathectomy: Evaluation of Long-term Outcomes

Abstract

Extended periarterial sympathectomy is an effective and safe procedure for patients with refractory Raynaud syndrome. Our data demonstrate long-term improvement in ischemic pain and sensibility, along with a high rate of ulcer healing and patient satisfaction.

Outcomes of periarterial sympathectomy in patients with digital ischemia

“…15 Extended distal periarterial sympathectomy is reported as a treatment option for digital ischemia since 1980. Pace and his coworkers 16 reported an ulcer healing success rate of 78% and an ischemia improvement rate of 94% in a series of 58 patients. They described a very invasive approach, where they exposed the ulnar artery, palmar arch, and digital arteries through on large incision, sometimes replacing a long segment of the ulnar artery with a vein graft.…”

“…These findings are comparable to other studies reported in the literature. [16][17][18] This strongly suggests that digital ischemia secondary to vasculitis is often very progressive, and refractory to pharmacological treatment. Upper limb, being less susceptible to atherosclerotic occlusive disease, is the playground of other pathologies, including-in addition to vasculitis-embolic disease, thoracic outlet syndrome, and occupational injury.…”

“…Again, this was very similar to the findings of previous studies. [16][17][18][19][20] These findings probably highlight the fact that pain relief should be a main determinant factor when choosing the type of surgical intervention for these cases. Sympathetic denervation does not only improve tissue perfusion by causing vasodilatation but additionally achieves significant pain relief by interrupting the pain conduction pathway.…”

“…This high success rate in healing is also reported in most of the previous similar studies. [16][17][18][19][20] Although the etiology for digital ischemia varies greatly among the patients included in those studies, yet distal sympathectomy seems to be the answer for all of these patients. The fact that sympathectomy directly affects skin and tissue blood distribution makes it a very effective treatment for digital skin ulceration irrespective of the underlying pathology.…”

Segmental branches emanating from saphenous nerve morphing into sympathetic trunks for innervation of saphenous artery and its clinical implication for arterial sympathectomy

“…The concept of periarterial sympathectomy was first suggested by Leriche more than a century ago, who, however, noted that the early vasodilation effect was later lost, prompting anatomists to cast doubt on the existence of long centripetal sympathetic nerves running along the arteries 28 . In order to improve the efficacy of sympathectomy, proximal sympathectomy at the spinal cord level was then proposed.…”