The microcirculatory effects of peripheral sympathectomy

Koman, L. Andrew; Smith, Beth Paterson; Pollock, F. Edward; Smith, Thomas L.; Pollock, David C.; Russell, Gregory B.

doi:10.1016/s0363-5023(05)80419-8

Cited by 83 publications

(80 citation statements)

References 16 publications

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“…1). As Koman et al 12 reported in 1995 and El-Gammal and Blair in 1991, 14 the radial and ulnar arteries are exposed at the wrist under loupe magnification (3.5×) through two parallel longitudinal incisions, and peripheral nerve connections are divided before stripping the adventitia. 2 These authors performed decompression arteriolysis over a 1-to 2-cm length, but we routinely extended this to a 4-cm segment (Fig.…”

Section: Surgical Techniquementioning

confidence: 99%

Surgery for ischemic pain and Raynaud's' phenomenon in scleroderma: A description of treatment protocol and evaluation of results

2001

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Although the literature suggests that palmar sympathectomy (PS) with or without vascular reconstruction may improve ischemic digital pain, fingertip ulceration, and cold intolerance in patients with scleroderma, the question regarding long-term efficacy still remains. This retrospective study of six patients (eight hands) operated on between 1995 and 1997 evaluates both early (6 months) and long-term (average, 2.5 years) outcome after PS in combination with decompression arteriolysis of the radial and ulnar arteries proximal to the wrist. When preoperative digital blood flow was inadequate based on noninvasive vascular studies and major inflow occlusion was present, vascular reconstruction was also performed when feasible. At early review, significant improvement in ischemic digital pain and moderate improvement in cold intolerance resulted in eight hands, and at final follow-up, this was sustained in seven hands. Preoperatively, digital ulcerations were present in six hands. After digital debridement and/or amputation, all wounds healed, but in one patient with bilateral disease who continued to smoke, ulcerations recurred without the need for subsequent surgery. Five of six patients were no longer dependent on narcotic analgesics, but use of vasodilator medication did not change. Five of six patients claimed significant improvement in the quality of life after surgery and reported that they would undergo the surgery again. PS in combination with radial and ulnar arteriolysis appears to be efficacious at both early and long-term review. When major inflow occlusion exists and digital blood flow is compromised, vascular reconstruction is recommended if possible. We review our treatment protocol in this complex population of patients.

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Section: Surgical Techniquementioning

confidence: 99%

Surgery for ischemic pain and Raynaud's' phenomenon in scleroderma: A description of treatment protocol and evaluation of results

2001

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“…Las enfermedades vasculares isquémicas para las que puede ser útil la simpatectomía son de tipo vasoespástico y vasoobstructivo 22,37 . Entre los procesos vasoespásticos destaca la enfermedad de Raynaud, en la cual se consigue en muchos casos una mejoría duradera con simpatectomía, aunque no son infrecuentes las recurrencias 22,37 .…”

Section: Vasculopatíasunclassified

“…Entre los procesos vasoespásticos destaca la enfermedad de Raynaud, en la cual se consigue en muchos casos una mejoría duradera con simpatectomía, aunque no son infrecuentes las recurrencias 22,37 . Los trastornos vasoobliterativos periféricos, como la enfermedad de Buerger o la macroglobulinemia, causan isquemia y necrosis tisular que se traducen en dolor y alteración funcional 22,37,76 .…”

Section: Vasculopatíasunclassified

“…Los trastornos vasoobliterativos periféricos, como la enfermedad de Buerger o la macroglobulinemia, causan isquemia y necrosis tisular que se traducen en dolor y alteración funcional 22,37,76 . El incremento del flujo vascular colateral tras la realización de simpatectomía (especialmente de T2) lleva a un incremento de la perfusión cutánea, una disminución del dolor isquémico y a una mejoría de las úlceras y tejidos necróticos, al menos temporalmente, ya que el proceso lesional suele continuar 22,37,76,84 .…”

Section: Vasculopatíasunclassified

“…La lesión del ganglio y de la cadena simpática es muy variada en la literatura: coagulación del ganglio, resección del ganglio, corte de la cadena simpática sin resección del ganglio, coagulación de la cadena simpática rostral y distal al ganglio, aplicación de clips a la cadena simpática 37,74 . En cualquier caso, se recomienda seccionar la cadena simpática rostral y caudalmente al ganglio, además de los ramos comunicantes y el nervio de Kuntz, que conecta los ganglios simpáticos a los nervios intercostales y al plexo braquial 38,63 .…”

Section: Figura 1 Introducción De La Vaina Y El Endoscopio Por El 4ºunclassified

See 2 more Smart Citations

Simpatectomía toracoscópica: una revisión de la literatura

Bejarano¹,

Manrique²

2010

Neurocirugía

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Effects of peripheral sympathectomy on thermoregulatory vascular control in the rabbit ear

et al. 1998

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A rabbit ear model of the human digit was utilized to determine the vascular response to peripheral sympathectomy. Vascular responses were evaluated by subjecting chronically instrumented rabbits to a cold stress before and after sympathectomy surgery. The typical response to cold stress is for ear temperatures and auricular cutaneous perfusion to decrease during the cooling phase of the test and to increase toward baseline levels during the rewarming phase after cold exposure. Following peripheral sympathectomy, ear temperatures were significantly increased during both the cooling and rewarming phase of the cold stress test although overall ear perfusion and skin perfusion were not different from sham-operated rabbits. The responses observed in the rabbit ear following peripheral sympathectomy appear to mimic those noted in patients receiving digital peripheral sympathectomies for the treatment of refractory pain and ulceration. Peripheral sympathectomy may result in clinical improvements in patients because it improves both total digital and nutritional cutaneous blood flow. Peripheral sympathectomy in normal rabbit ears does not result in altered perfusion patterns with cold exposure although ear temperature is significantly higher. This pattern of changes suggests that the distribution of extremity perfusion is altered even though overall extremity perfusion and cutaneous perfusion per se are not significantly different from sham-operated controls. Complete sympathectomy was accompanied by a persistent increase in ear temperature and a dissociation between conductance and microvascular perfusion. Auricular conductance was transiently increased and then decreased to levels below preoperative control values. Microvascular perfusion is decreased immediately following amputation/replantation and thereafter increases.

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The microcirculatory effects of peripheral sympathectomy

Cited by 83 publications

References 16 publications

Surgery for ischemic pain and Raynaud's' phenomenon in scleroderma: A description of treatment protocol and evaluation of results

Surgery for ischemic pain and Raynaud's' phenomenon in scleroderma: A description of treatment protocol and evaluation of results

Simpatectomía toracoscópica: una revisión de la literatura

Effects of peripheral sympathectomy on thermoregulatory vascular control in the rabbit ear

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