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PubMed2006

Thoracoscopic sympathectomy for isolated facial blushing.

BACKGROUND: Facial blushing is one of the most peculiar of human expressions and has become a cardinal symptom of social phobia. The pathophysiology is unclear and the prevalence is unknown. Thoracoscopic sympathectomy may cure the symptom, but very few surgeons treat patients with isolated facial blushing. The literature is limited, and there are few long-term follow-up studies. METHODS: A follow-up study by questionnaire in 180 consecutive patients who underwent thoracoscopic sympathectomy for isolated facial blushing at two Danish university hospitals during a 6-year period. Patients routinely underwent T2 sympathectomy at the university hospital in Aarhus (n = 101) and T2-T3 sympathectomy at the university hospital in Odense (n = 79). RESULTS: The questionnaire was returned by 96% of the patients after a median follow-up time of 20 months. Overall, 90% of the patients had some effect from the operation, and the result was excellent or satisfactory in 75%. There was no significant difference between the two extents of sympathectomy. Compensatory sweating occurred in 88% of all patients and was significantly more frequent after T2-T3 sympathectomy (p = 0.02) Ten percent of our patients regretted the operation because of side effects or no effect of the operation. CONCLUSIONS: This study demonstrates that thoracoscopic sympathectomy is an effective treatment for isolated facial blushing. The majority of patients achieve an excellent or satisfactory long-term result. Our results suggest that a T2 sympathectomy is superior for patients with isolated facial blushing because side effects are lower compared with a T2-T3 sympathectomy.

Adolescent↗
PubMed2002

Surgical sympathectomy for reflex sympathetic dystrophy syndromes.

PURPOSE: The purpose of this study was the assessment of the efficacy of thoracoscopic cervicodorsal and open lumbar sympathectomy for the reduction of pain severity and disability associated with reflex sympathetic dystrophy (RSD). METHODS: From 1992 to 2000, 73 patients with RSD underwent 46 video-assisted thoracoscopic (first to fourth thoracic ganglion) or 37 surgical lumbar (first to fourth lumbar ganglion) sympathetic chain resections. The patients were referred from multidisciplinary pain clinics with documented sympathetically maintained pain syndrome on the basis of reproducible more than 50% reduction in pain severity score (0, no pain; 10, most severe pain imaginable) for more than 2 days after sympathetic block therapy. The mean duration of the RSD symptoms before sympathectomy was 26 plus minus 14 months (range, 6 to 100 months). Postoperative pain severity score, limb disability, and overall patient satisfaction were assessed by an independent third-party observer at a mean follow-up period of 30 months. RESULTS: No operative mortality or serious morbidity (Horner's syndrome, bleeding that needed transfusion, wound infection) occurred. Transient (<3-month) postprocedural sympathalgia developed in one third of the patients for cervicodorsal sympathectomy and 20% of the patients for lumbar sympathectomy and was treated effectively with trigger point/proximal ganglion block therapy or transcutaneous electrical nerve stimulation. At 3 months after sympathectomy, 10% of the patients had conditions that were judged treatment failures with no reduction in pain severity or limb disability. The remaining patients testified to more than 50% pain reduction, with pain severity scores decreasing from a mean of 8.7 before surgery to 3.4 after sympathectomy. At 1 year, one quarter of the patients had continued significant pain relief (pain severity score, <3) and an additional 50% of the patients indicated continued but reduced pain severity and an increase in daily/work activities. Overall, patient satisfaction (willingness to have procedure again, benefit from sympathectomy) was 77% and was not significantly influenced by patient age, RSD duration/stage, or extremity involvement (lumbar, 84%; cervicodorsal, 72%). CONCLUSION: Patients with RSD with a confirmed sympathetically maintained pain syndrome can realize long-term benefit from surgical sympathectomy. Procedural efficacy was similar for both upper limb and lower limb RSD syndromes, although the level of pain reduction did deteriorate with time. After sympathectomy, the patients with RSD had a low incidence rate (7%) of "new" complex regional pain or disabling compensatory sweating syndromes.

Adolescent↗
PubMed1999

Changes in hemodynamics of the carotid and middle cerebral arteries before and after endoscopic sympathectomy in patients with palmar hyperhidrosis: preliminary results.

OBJECT: The purpose of this study was to analyze the change in carotid and middle cerebral artery (MCA) hemodynamics before and after endoscopic upper thoracic sympathectomy in patients with palmar hyperhidrosis (PH). METHODS: Sixty-eight patients with PH (35 males and 33 females) for whom the average age was 24.5+/-10.7 years (+/- standard deviation) were recruited into this study. These patients all underwent routine upper T-2 sympathectomy to treat their PH. Ultrasonography studies of the carotid arteries (CAs) and MCA were obtained in each patient before and after T-2 sympathectomy. The blood flow volume, flow velocity, and resistivity index (RI) in the bilateral common CAs (CCAs), internal CAs (ICAs), and external CAs (ECAs) were evaluated using duplex ultrasonography. The systolic peak velocity, mean velocity, diastolic peak velocity, pulsatility index, and RI of the bilateral MCAs were evaluated using transcranial Doppler ultrasonography. Blood pressure and heart rate were also recorded during this study. The Student paired t-test was used to analyze the differences between studies before and after bilateral T-2 sympathectomy. There was a significant reduction in diastolic pressure after T-2 sympathectomy (p = 0.003), but not in systolic pressure or heart rate. The vessel diameter was increased after sympathectomy in the left CAs and right CCA. The T-2 sympathectomy led to significant elevation of blood flow volume and RI in the left CCA, ICA, and ECA (p < 0.05). The authors found significant increases in maximum flow velocity and RI in the left MCA (p < 0.05). CONCLUSIONS: Patients who underwent T-2 sympathectomy demonstrated a significant increase in blood flow volume and flow velocities of the CAs and MCA, especially on the left side. Asymmetry of sympathetic influence on the hemodynamics of the CAs and MCA was noted. The usefulness of sympathectomy for the treatment of ischemic cardiovascular and cerebrovascular disease deserves further investigation.

Adolescent↗
PubMed2006

[Comparison of curative effects of sympathectomy at different segments on palmar hyperhidrosis].

OBJECTIVE: To compare the curative effects of sympathectomy at different segments on palmar hyperhidrosis. METHODS: Four hundred patients with palmar hyperhidrosis, 191 males and 209 females, aged 21.9 +/- 3.4 (10 - 53), underwent bilateral sympathectomy However, bilateral sympathectomy was forced to be given up and replaced by unilateral sympathectomy in 2 patients because of severe pleural adhesion The 398 patients on which bilateral sympathectomy was successfully performed were randomly divided into 3 groups: Group A (n = 207) undergoing T2-4 sympathectomy, Group B (n = 131) undergoing T3 sympathectomy, and Group C (n = 60) undergoing T3-4 sympathectomy. The curative effects were compared. RESULTS: Operation was successfully performed on all patients and their palmar hyperhidrosis was completely alleviated after operation. No surgery-related post-operative complication occurred. The compensatory hyperhidrosis (CH) rate of Group B was 5.3%, not significantly different from that of Group C (6.7%, P > 0.05). The CH rate of the combined group, Group B + C was 5.8%, significantly lower than that of Group A (28.0%, P < 0.01). CONCLUSION: Safe and mini-invasive, T3 or T3-4 sympathectomy effectively reduce the development of CH and improves the patients' quality of life post-operatively.

Adolescent↗
PubMed1994

Alterations of the three-phase bone scan after sympathectomy.

OBJECTIVE: To evaluate alterations of the three-phase bone scan (TPBS) in patients with the clinical diagnosis of reflex sympathetic dystrophy (RSD) before and after surgical or chemical sympathectomy. DESIGN: The TPBS was done after i.v. administration of 99technetium dimethylphosphonate. Scans were read by one blinded and one nonblinded reviewer (as to site of symptoms and procedure), using a visual grading system devised in our institution. Since there were no statistically significant differences between the two examiners' scores for blood flow, pool, and delayed phases, all scores were averaged and used for comparison before and after sympathectomy. SUBJECTS: Ten women and four men with RSD were observed with 17 TPBSs before and 30 TPBSs after surgical (n = 6) or chemical (n = 8) sympathectomy. RESULTS: All three phases of TPBS were significantly enhanced after sympathectomy in 11 of 14 patients in a pattern indistinguishable from that very commonly reported in florid RSD. The increased uptake occurred within 24 h after the procedure, normalized as early as 3 months in some scans, and remained abnormal in some patients in the 12-month follow-up period. In total, only 33% of all sympathectomies performed led to long-term symptom relief. CONCLUSIONS: The data demonstrated that alterations in TPBS after sympathectomy are identical to those reported in early RSD and these alterations bear no relationship to the success of sympathectomy regarding pain relief. The mechanisms underlying alterations of TPBS as well as the potential mechanisms of sympathectomy failures are discussed.

Adolescent↗
PubMed1988

Comparison of effects of surgical and chemical sympathectomy on beta adrenergic and muscarinic receptors of parotid gland of young and adult rats.

Surgical (removal of a superior cervical ganglion) or chemical [(administration of a single dose of 6 hydroxydopamine (6 OHDA) (50 mg/kg dose body wt)] sympathectomy of rats at 2 or 8 days of age resulted in an increase in [3H]DHA binding of membranes of parotid gland of young rats (age range 21 days to 48 days). The increase progressed with postnatal age; at 21 days of age (surgical sympathectomy), it was 13%; at 32 days of age with 6 OHDA, it was as much as 34%, but only 26% at 42 days of age with surgical sympathectomy. No change in [3H]QNB binding was observed at any postnatal ages following neonatal sympathectomy. Conversely, surgical sympathectomy of the parotid of adult rat resulted in little or no change in [3H]DHA binding at 1, 2, 3, or 4 weeks postdenervation, but [3H]QNB binding was reduced at all periods, with the reduction from control values at 2 weeks being 34%, and at the subsequent intervals, 24-26%. The increase in number of beta adrenoceptors of the parotid gland was not related to the kind of sympathectomy (chemical or surgical) or neonatal age at which it was done; however, duration of the denervation for 2-3 weeks was necessary for the receptor increase to occur. In the adult, however, the duration of the denervation was of no importance since change in number of beta adrenoceptors did not occur at 1, 2, 3, or 4 weeks after surgical denervation but did occur after only 1 week after of reserpine-induced denervation. QNB binding was decreased with surgical sympathectomy as well as reserpine-induced sympathectomy of adult parotid gland; norepinephrine concentration was decreased to levels of a few percent of innervated glands. The relation between development of glandular supersensitivity and increase in beta adrenoceptors is discussed.

Aging↗
PubMed1998

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

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.

Animals↗
PubMed2004

Severity of compensatory sweating after thoracoscopic sympathectomy.

BACKGROUND: Compensatory sweating is a well-known side effect after sympathectomy for hyperhidrosis. It is often claimed to correlate with the extent of sympathectomy, but results from the literature are conflicting, and few have actually considered differences in the intensity of compensatory sweating. METHODS: A total of 158 patients underwent thoracoscopic sympathectomy for primary hyperhidrosis or blushing, or both. Sympathectomy was performed bilaterally at Th2 for facial hyperhidrosis/blushing (n = 49), Th2-3 for palmar hyperhidrosis (n = 62), and Th2-4 for axillary hyperhidrosis (n = 47). RESULTS: Follow-up by questionnaire was possible in 94% of patients after a median of 26 months. Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation. CONCLUSIONS: Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis. We found no significant difference between the level of sympathectomy and the occurrence of compensatory sweating. However, it appears that this is the first study to demonstrate that severe sweating is significantly more frequent after Th2-4 sympathectomy for axillary hyperhidrosis. We encourage informing patients thoroughly about these side effects before surgery.

Adolescent↗
PubMed2005

Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans.

BACKGROUND: Upper thoracic sympathectomy is used to treat several disorders. Sympathetic nerve fibers emanating from thoracic ganglia innervate the heart. Whether unilateral or bilateral upper thoracic sympathectomy affects cardiac sympathetic innervation in humans in vivo has been unclear. OBJECTIVES: The purpose of this study was to assess whether thoracic sympathectomy decreases cardiac sympathetic innervation, as indicated by positron emission tomographic scanning after intravenous injection of the sympathoneural imaging agent 6-[18F]fluorodopamine. METHODS: Nine patients with previous upper thoracic sympathectomies (four right-sided, one left-sided, four bilateral) underwent thoracic 6-[18F]fluorodopamine scanning between 1 and 2 hours after injection of the imaging agent. In each case, a low rate of entry of norepinephrine into the arm venous drainage (norepinephrine spillover) verified upper limb sympathectomy. Data were compared with those from the interventricular septum of patients with cardiac sympathetic denervation associated with pure autonomic failure and from normal volunteers. RESULTS: All four patients with bilateral sympathectomy had low septal myocardial 6-[18F]fluorodopamine-derived radioactivity (2,673 +/- 92 nCi-kg/cc-mCi at an average of 89 minutes after injection) compared with normal volunteers (3,634 +/- 311 nCi-kg/cc-mCi at 83 minutes, N = 22, P = .007) and higher radioactivity than in patients with pure autonomic failure (1,320 +/- 300 nCi-kg/cc-mCi at 83 minutes, N = 7, P = .003). Patients with unilateral sympathectomy had normal 6-[18F]fluorodopamine-derived radioactivity (3,971 +/- 337 nCi-kg/cc-mCi at 87 minutes). CONCLUSIONS: Bilateral upper thoracic sympathectomy partly decreases cardiac sympathetic innervation density.

Analysis of Variance↗
PubMed2000

Alterations in T lymphocyte activity following chemical sympathectomy in young and old Fischer 344 rats.

In aged Fischer 344 (F344) rats, sympathetic noradrenergic (NA) innervation of the spleen is markedly diminished compared with young rats. To determine if diminished NA innervation can still provide functional signals to splenic T cells, young (3 months old) and old (17 months old) F344 rats were treated with the NA-selective neurotoxin, 6-hydroxydopamine (6-OHDA) to destroy peripheral NA nerve fibers. In 3-month-old rats, no alterations in spleen cell Con A-induced T cell proliferation, IL-2 or IFN-gamma production were observed up to 15 days after sympathectomy, when splenic NE was maximally depleted. By 21 days post-sympathectomy, when NE levels had partially recovered, Con A-induced proliferation and IFN-gamma production, but not IL-2 production, were reduced in sympathectomized animals. After day 21 post-sympathectomy, no alterations in T cell functions were observed in sympathectomized animals. In 17-month-old rats, spleen cell Con A-induced proliferation and IL-2 production were reduced 5 days after sympathectomy in the absence of changes in CD5+ T cells or IFN-gamma production. Desipramine pretreatment, to block 6-OHDA uptake and prevent sympathectomy, completely blocked the 6-OHDA-induced effects, demonstrating that the destruction of NA nerve fibers is required. After day 5 post-sympathectomy, no sympathectomy-induced alterations in Con A-induced T cell functions were observed in old animals. These differences between young and old rats demonstrate that old animals are more susceptible to loss of sympathetic NA innervation, perhaps because compensatory mechanisms are limited. The sympathectomy-induced reduction in T cell proliferation indicates that splenic NA innervation in old animals, though diminished, can exert a positive regulatory influence on T lymphocyte function. Further study of sympathetic neural-immune interactions in the aged rat may provide a means to improve T cell responsiveness in aging.

Aging↗
PubMed1999

The changes seen in balloon-injured porcine femoral arteries following sympathectomy.

On the basis that vasoconstriction may contribute to restenosis following angioplasty, the influence of lumbar sympathectomy on the morphometry of femoral arteries after balloon injury was examined in a pig model. Twenty-six juvenile pigs underwent balloon de-endothelialization of the right femoral artery followed by an open bilateral lumbar sympathectomy (n = 14) or a sham sympathectomy (n = 12). Four weeks later flow was measured in femoral arteries. Animals were then killed and the femoral arteries were perfusion-fixed and harvested. Sympathectomy resulted in a significant (P = 0.04) increase in flow in both the injured (right) and uninjured (left) femoral arteries. Sympathectomy did not inhibit intimal thickening following balloon injury: median (interquartile range) intimal area was 0.4 mm2 (0.3-0.9) in the sympathectomy group versus 0.5 mm2 (0.4-0.9) in the sham group. Sympathectomy did, however, result in a significant (P = 0.02) increase in the lumen area: 1.1 mm2 (0.8-1.8) versus 0.7 mm2 (0.6-0.9). Sympathectomy may reduce vasospasm following angioplasty with the potential for clinical benefit.

Animals↗
PubMed1999

The synergistic effect of sympathectomy and hyperbaric oxygen exposure on transcutaneous PO2 in healthy volunteers.

UNLABELLED: The benefit of hyperbaric oxygen (HBO2) exposure is dependent on the oxygen delivery. Such benefit may be limited by the fact that hyperoxia causes vasoconstriction and decreases blood flow. The aim of this study was to determine whether regional sympathectomy attenuates this vasoconstriction response and thus improves oxygen delivery. In a double-blinded manner, healthy volunteers were subjected to HBO2 in a monoplace chamber on two occasions separated by at least 1 wk. Transcutaneous oxygen (tcPO2) and carbon dioxide (tcPCO2) on the forearm were monitored continuously, and blood flow in the axillary artery was measured using angiodynography before and after exposure to HBO2. During one visit, each volunteer received a sympathetic block to the upper extremity by an injection of lidocaine into the brachial plexus at the axilla. During a second visit, the volunteer received a placebo injection of isotonic sodium chloride solution into the brachial plexus of the same side. Skin temperature was recorded on the back of the hand. All subjects exhibited a small but significant increase in skin temperature (2.5%) and in upper limb blood flow (23%) (P < 0.05%) after sympathectomy, but not after isotonic sodium chloride solution injection. Sympathectomy increased tcPO2 marginally while in room air. However, during HBO2, tcPO2 was substantially and significantly higher (409.8+/-98.8 mm Hg) after sympathectomy compared with that after isotonic sodium chloride solution injection (171.3+/-38.1 mm Hg). tcPCO2 did not change significantly after sympathectomy or during HBO2. Thus, sympathectomy presumably improved oxygen delivery by preventing vasoconstriction during hyperoxia. The results suggest that sympathectomy may be a useful adjunct to HBO2 therapy in patients in whom vascular resistance is increased because of sympathetic tone or hyperoxia. IMPLICATIONS: Sympathetic nerve block of the extremities markedly enhances tissue oxygen delivery during hyperbaric oxygen treatment. Sympathectomy may be a beneficial adjunct treatment to hyperbaric oxygen in peripheral vascular insufficiency.

Adult↗
PubMed1996

Effects of short- and long-term sympathectomy on vasoconstrictor responses of the rat mesenteric arterial bed.

1. The effects of short- and long-term sympathectomy were evaluated on vasoconstrictor function of constantly perfused mesenteric arterial beds isolated from rats: the effects of short-term sympathectomy were assessed at 3 and 8 days after 6-hydroxydopamine (6-OHDA) treatment of adult rats; the effects of long-term sympathectomy were assessed in adult rats treated at youth with guanethidine. 2. The relative degree of residual sympathetic innervation of the mesenteric arterial preparations was assessed by responses to electrical field stimulation (EFS; 16 Hz, 1 ms, 90 V, 30 s). Control responses were 95.6 +/- 3.9 mmHg (n = 35). Responses after sympathectomy were: 3 days after 6-OHDA, 2.9 +/- 0.9 mmHg (n = 15) < 8 days after 6-OHDA, 14.1 +/- 2.1 mmHg (n = 14) < guanethidine, 21.1 +/- 4.1 mmHg (n = 16). 3. Three days after 6-OHDA treatment there was an increase in the sensitivities of response to vasopressin and endothelin, producing leftward shifts of the dose-response curves of 0.66 +/- 0.11 and 0.88 +/- 0.13 log units respectively (n = 7-11), and a small increase in sensitivity of responses to noradrenaline (NA) and ATP. The maximal response to 5-hydroxytryptamine (5-HT) was increased. In contrast, there was a decrease in maximal constriction to NA and to the alpha 1-adrenoceptor agonist methoxamine. The alpha 2-adrenoceptor agonist clonidine did not elicit vasoconstriction at basal tone. There was no difference in vasodilator responses to the beta-adrenoceptor agonist isoprenaline in preparations with tone raised with prostaglandin F2 alpha (PGF2 alpha; 0.1-0.3 microM). 4. Eight days after 6-OHDA sympathectomy there was no significant difference in sensitivities or maximal responses to ATP, vasopressin and endothelin, but a small increase in the sensitivity of responses to 5-HT. Maximal responses to NA and methoxamine were significantly lower than the controls, but sensitivities were similar. There was no significant difference in vasodilator responses to isoprenaline in PGF2 alpha-raised tone preparations. 5. After long-term guanethidine sympathectomy maximal responses to 5-HT and NA were significantly reduced. Responses to ATP, vasopressin and endothelin were unchanged. 6. In mesenteric arterial preparations from untreated rats, ouabain (0.1 mM), a blocker of the Na+/K+ pump, significantly augmented the sensitivity and maximal responses to EFS, NA, methoxamine and 5-HT. Responses to ATP, vasopressin and endothelin were unaffected. 7. It is concluded that in the rat mesenteric arterial bed, short-term sympathectomy, where only 3% of the sympathetic nerve-mediated response remained, results in non-uniform changes in sensitivity and maximal responses to different vasoconstrictors, which cannot be entirely explained by changes in the Na+/K+ pump. Most of these changes disappeared at 8 days after 6-OHDA treatment, when nerve-mediated responses had partially returned. After long-term guanethidine sympathectomy, there was little change in responses to vasoconstrictors, and nerve-mediated responses were reduced to 22%. Although the variable factors are complex, it appears that in general, changes in responses of smooth muscle to vasoconstrictor substances after sympathetic denervation only occur if there is near-complete loss of nerve-mediated responses.

Adrenergic alpha-Agonists↗
PubMed2005

Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia.

PURPOSE: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance. MATERIALS AND METHODS: Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularisation. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities. RESULTS: Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the months immediately following the procedure. DISCUSSION: Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limbs. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of CT-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation.

Aged↗
PubMed1985

Effect of sympathectomy on microvascular anastomosis in the rat.

An operative technique of lumbar sympathectomy in the rat is described. Two days following either sympathectomy or sham-sympathectomy, bilateral femoral arterial anastomoses were performed by a 1-year trained microsurgeon (S.A.H.) and patency was assessed by preoperative and postoperative (30 minutes, daily) operative invasive and noninvasive techniques using an electromagnetic flow meter (for immediate postoperative) and Doppler, respectively. Of 112 rats, three and one postoperative deaths occurred within 24 hours following abdominal surgery in each group, respectively. Of 105 anastomoses in the sympathectomy group, 103 (98%) and 101 (96%) had patent anastomoses 30 minutes and 14 days postoperatively, respectively, while 109 of the sham-sympathectomy group had 105 (96%) and 103 (94%) patencies at the same period of the observation, respectively. Thus the sympathectomy did not much alter the microvascular patency rate in the rat. It appears therefore that the meticulous microvascular anastomosis cannot be replaced by lumbar sympathectomy in the rat.

Animals↗
PubMed2001

Laparoscopic lumbar sympathectomy for lower-limb disease.

BACKGROUND: The standard procedure for sympathectomy is open surgery. The oblique retroperitoneal approach is popular because it provides good visibility, albeit at the expense of requiring a long skin incision. Chemical sympathectomy has been introduced as a less invasive means of achieving sympatholysis; however, this method is also associated with a significant incidence of incomplete block and transient denervation. Laparoscopic surgery is a new approach that simplifies various surgical procedures. The aim of our report was to evaluate the benefits of endoscopic retroperitoneal surgery for lumbar sympathectomies. METHODS: Between March 1997 and April 2000, seven patients underwent laparoscopic lumbar sympathectomy in our department (all men, with an average age or 45.1 years). The predominant presenting symptoms were unilateral pain at rest and lower-extremity coldness. Symphaectomy was performed using a retroperitoneal approach on six patients and an anterior transperitoneal approach on one patient. After laparoscopic lumbar sympathectomy, skin thermometry was carried out on all patients. RESULTS: The postoperative skin temperature of the affected leg rose to 36.6 +/- 0.5 degrees C, as compared to 33.8 +/- 0.8 degrees C preoperatively. After laparoscopic lumbar sympathectomy, none of the patients complained of neuralgia. All patients achieved sustained symptomatic relief, and no major postoperative complications were noted. CONCLUSIONS: Lumbar sympathectomy can be performed laparoscopically. Currently, our standard technique is the retroperitoneal approach. More clinical experience and long-term follow-up will ultimately determine if this will become the procedure of choice. However, we believe that a learning period is necessary for this technique to be fully mastered.

Adult↗
PubMed1991

Perivascular sympathectomy does not remove adrenergic nerves from distal vessels. The effect of various denervations on the rat saphenous bundle: a histochemical study.

It has been claimed earlier that perivascular sympathectomy removes distal adrenergic innervation of the vessels. Based on preliminary results suggesting the contrary, the purpose of this work was to reconsider the denervation effect of perivascular sympathectomy. We operated on 40 rats using different denervation methods mainly to test the effects of perivascular sympathectomy on the distal saphenous vessels of the leg. The operations were performed on the right leg, while the left leg was used as a control. Samples were taken 2 days after the operations for glyoxylic acid-induced fluorescence examination for the histochemical demonstration of adrenergic nerves. Perivascular sympathectomy seemed to remove the adrenergic innervation only from the operated segment of the vessel. There was a short segment of diminished innervation a few millimeters in length just distal to the perivascular sympathectomy while the more distal adrenergic nerves around the vessels appeared to be normal. When the saphenous nerve was cut the adrenergic innervation seemed to disappear for 1 cm and to continue to be diminished at the medial malleolus site. Lumbar sympathectomy did not seem to remove the distal adrenergic nerves around the vessels, but caused only a slight decrease in innervation. It can be concluded that the peripheral adrenergic innervation is apparently normal after perivascular sympathectomy and that the operation does not have the previously assumed denervation effects.

Adrenergic Fibers↗
PubMed2002

Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomy.

BACKGROUND: We tested the hypothesis that no right-sided dominance exists after infrastellate surgical upper-thoracic sympathectomy. We aimed to confirm whether a significant bradycardia was constant and only dependent on the right side. METHODS: We performed 24-hour Holter electrocardiographic recordings in 12 patients referred for bilateral sympathectomy. Surgery was performed at two distinct times allowing for the study of the consequences of unilateral right and bilateral sympathectomy. RESULTS: Heart rate was 77 +/- 8 beats per minute before surgery on the 24-hour recording and significantly decreased after bilateral (67.8 +/- 6.5 beats per minute; p < 0.05) but not after unilateral right sympathectomy. Consistently spectral analysis variables significantly changed after bilateral surgery but showed no right-sided dominance. Little effect of sympathectomy was found on the QT interval, which tended to decrease after bilateral sympathectomy. CONCLUSIONS: Patients should be informed of the bradycardia resulting from sympathectomy. No right-sided dominance can be found consistently with the random distribution of substellate cardiac fibers reported in anatomic studies.

Adult↗