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Cervicothoracic sympathectomy for Raynaud's syndrome
R C Lowell1, P Gloviczki, K J Cherry
1Division of Vascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota.
Summary
Surgical sympathectomy for Raynaud's syndrome offers initial symptom relief in 95% of cases but recurrence is common within six months. This procedure is reserved for severe, refractory cases unresponsive to medical therapy.
Area of Science:
- Vascular Surgery
- Neurology
Background:
- Raynaud's syndrome involves episodic digital ischemia triggered by cold or stress.
- Medical management is typically effective, but surgical intervention is considered for severe, refractory cases.
Purpose of the Study:
- To evaluate the efficacy and outcomes of surgical sympathectomy for Raynaud's syndrome.
Main Methods:
- Retrospective review of 3,219 patients diagnosed with Raynaud's syndrome over 10 years.
- Analysis of 20 cervical or thoracic sympathectomies performed in 14 patients for severe Raynaud's syndrome.
- Transaxillary or supraclavicular resection of the sympathetic chain (T1-T4 ganglions).
Main Results:
- Initial symptom resolution or improvement occurred in 19 out of 20 limbs (95%).
- Digital ulcers healed in treated patients.
- Persistent or recurrent symptoms were observed in all patients after six months.
- Five patients developed postoperative Horner's syndrome.
Conclusions:
- Surgical sympathectomy provides temporary relief for severe Raynaud's syndrome but has a high recurrence rate.
- Potential causes for recurrence include nerve regeneration or incomplete sympathectomy.
- The procedure is reserved for select patients with disabling symptoms unresponsive to medical treatment.