Peripheral sympathectomy for Raynaud's phenomenon: a salvage procedure

Area of Science:

• Vascular Surgery
• Hand Surgery
• Regenerative Medicine

Background:

• Severe Raynaud's phenomenon can lead to chronic digital ischemic changes, including pain, ulceration, and gangrene.
• Patients with advanced digital ischemia often fail to respond to pharmacologic or other nonsurgical treatments.
• Microvascular reconstruction may be unfeasible due to multifocal arterial lesions in affected digits.

Observation:

• A retrospective review included 14 digits from six patients with severe Raynaud's phenomenon unresponsive to conservative therapies.
• Angiography revealed multifocal arterial lesions, precluding microvascular reconstruction in all cases.
• Peripheral sympathectomy was performed as a salvage procedure to prevent digit amputation.

Findings:

• Peripheral sympathectomy resulted in ulcer healing in 12 of 14 digits, successfully avoiding amputation.
• In the remaining two digits, ulcers showed improvement, and progressive gangrene was limited.
• The procedure demonstrated significant efficacy in improving digital perfusion and preserving digits.

Implications:

• Peripheral sympathectomy serves as a viable salvage procedure for recalcitrant Raynaud's phenomenon.
• This surgical intervention can prevent digit amputation by enhancing blood flow to ischemic extremities.
• The findings support considering sympathectomy when conservative treatments fail in advanced cases of Raynaud's phenomenon.