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Thoracic sympathectomy for upper extremity ischemia.

Frank Hoexum1, Hans M Coveliers, Joyce J Lu

  • 1Department of Vascular Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands - frankhoexum@hotmail.com.

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|May 14, 2016
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Summary

Thoracic sympathectomy offers significant short-term relief for upper extremity ischemia, particularly in Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP). While benefits may diminish over time for PRD, it remains a valuable option for symptom management and tissue preservation.

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Area of Science:

  • Vascular Surgery
  • Surgical Procedures
  • Ischemia Management

Background:

  • Thoracic sympathectomy is a treatment for various upper extremity disorders.
  • Upper extremity ischemia necessitates evaluation of surgical interventions.

Purpose of the Study:

  • To systematically review the contemporary results of thoracic sympathectomy for upper extremity ischemia.
  • To analyze treatment outcomes for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP).

Main Methods:

  • Systematic literature review of PubMed, EMBASE, and Cochrane databases (1975-2015).
  • Inclusion of studies with original patient data on symptom improvement or ulcer healing.
  • Separate analyses for PRD and SRP.

Main Results:

  • Early benefits observed in 63-100% of all patients (median 94%).
  • High early efficacy in PRD (median 98%) and SRP (median 94%).
  • Long-term benefits varied: 13-100% (median 75%) overall, with better durability in SRP (median 79%) compared to PRD (median 58%).
  • Ulcer healing achieved in 33-100% of patients.

Conclusions:

  • Thoracic sympathectomy is beneficial for select patients with upper extremity ischemia.
  • Symptom reduction is possible in PRD, though effects may lessen over time.
  • Longer-lasting effects are noted in SRP, aiding tissue preservation and preventing amputation.