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PubMed1987

Response to brief coronary stenosis in conscious dogs after ventricular sympathectomy.

Left ventricular responses to 2-min circumflex occlusion were studied in conscious dogs. In nonsympathectomized controls at 2, 4, and 8 wk after surgery for cardiac instrumentation, segmental shortening in the posterior ventricle significantly decreased by 111, 87, and 81% of the preocclusion values, respectively (P less than 0.05). The decrease in shortening was associated with increases in end-diastolic pressure of 9, 9, and 8 mmHg (P less than 0.05), decreases in the maximal rate of pressure generation of 305, 272, and 340 mmHg/s (P less than 0.05), and increases in heart rate of 28, 21, and 20 beats/min, respectively (P less than 0.05). After 2 and 4 wk of ventricular sympathectomy, posterior segmental shortening declined by 38 and 31%, respectively (P less than 0.05), but these decreases were less than in controls (P less than 0.05). Shortening did not change during occlusion after 8 wk of sympathectomy. Diastolic pressure increased by 6 mmHg (P less than 0.05), and the rate of pressure generation decreased by 232 mmHg/s (P less than 0.05) in the 2-wk sympathectomized ventricle. These variables did not change significantly after 4 and 8 wk of sympathectomy. After 2, 4, and 8 wk of sympathectomy, the increases in heart rate during circumflex occlusion were not different from controls (P greater than 0.05). Thus chronic sympathectomy preserved ventricular function during occlusion. This effect was attributable to a reduced preocclusion mechanical performance with a reduction in blood flow requirement and to an increased collateral perfusion, as indicated by a higher peripheral coronary pressure during occlusion in sympathectomized ventricles.

Animals↗
PubMed1988

Carotid bifurcation sympathectomy and deafferentation: respiration during hypercapnia.

The respiratory effects of hypercapnia were studied in six awake cats 1) after bilateral sympathectomy of the carotid bifurcations and 2) after bilateral section of the carotid sinus nerves. When cats breathed either 2 or 4% CO2 in air, neither denervation affected the absolute level of ventilation, the percent change in ventilation, or the range of breath-to-breath variability in ventilation (V). However, in all six cats tidal volume (VT) increased for some levels of breath V after sympathectomy of the carotid bifurcations during inhalation of 4% CO2 in air. Moreover, after the subsequent carotid deafferentation, increased VT during fractional concentration of inspired CO2 (FICO2) of 4% persisted in four of six cats. Thus increased VT after sympathectomy could not be attributed to increased carotid chemoreceptor afferent activity but may have been due to reduced baroreceptor activity. On the other hand, sympathectomy-induced differences in breath timing, present during inhalation of 2% CO2, were reversed to intact values after sinus nerve section. In contrast to 2% CO2, changes in respiratory timing in intact cats associated with 4% CO2 were not altered significantly by sympathectomy or deafferentation of the carotid bifurcations. The latter indicates that above a critical FICO2 central mechanisms, unrelated to the carotid bifurcation, dominated respiratory timing in the hypercapnic awake cats.

Animals↗
PubMed1996

Effect of deferoxamine and sympathectomy on vasospasm following subarachnoid hemorrhage.

We examined the effects of subarachnoid hemorrhage (SAH) and treatment with deferoxamine (DFO) or sympathectomy on vascular smooth muscle function, as well as the underlying mechanisms involved, by recording the responses to nor-adrenaline and serotonin in isolated carotid arteries in vitro. All studies were performed before and 7 days after SAH. An experimental subarachnoid hemorrhage model was created in rabbits by injecting autologous arterial blood into the subarachnoid space of the rabbits via cisterna magna punction. During the chronic stage of vasospasm following SAH deferoxamine (DFO) was given to the animals and cervical and periarterial sympathectomy was performed in the other groups of animals. In isolated carotid arteries noradrenaline (10(-8) to 10(-4) mol/l) and serotonin (10(-8) to 10(-4) mol/l) produced concentration-dependent contractions. These contractile responses were significantly enhanced in animals 7 days after SAH compared to controls and did not return to control values in carotid arteries obtained from animals treated with DFO or sympathectomy for 7 days after SAH. These results show that SAH causes supersensitivity in the carotid as well as cerebral arteries during the first week after SAH and could contribute to the development of cerebral vasospasm. Both treatment with DFO and sympathectomy after SAH did not reduce the contractile responses to noradrenaline and serotonin in the carotid arteries. In conclusion, treatment with DFO or sympathectomy during the chronic stage of vasospasm after SAH did not affect the vascular responses of the extradural part of the carotid artery to vasoactive substances.

Animals↗
PubMed2005

Sympathectomy or doxazosin, but not propranolol, blunt myocardial interstitial fibrosis in pressure-overload hypertrophy.

The adaptive changes that develop in the pressure-overloaded left ventricular (LV) myocardium include cardiomyocyte hypertrophy and interstitial fibrosis. Although the former is known to depend to a sizeable extent on sympathetic (over)activity, little information exists whether the same applies to the latter, ie, whether excess catecholamine exposure contributes to the imbalance between collagen deposition by fibroblasts and degradation by matrix metalloproteases (MMPs), eventually leading to LV collagen accumulation. Sprague-Dawley rats were subjected to abdominal aortic banding (B) or sham operation (S) and treated with beta-blockade (Bb, oral propranolol, 40 mg/kg per day), chemical sympathectomy (Sx, 6-hydroxydopamine, 150 mg/kg intraperitoneal twice per week) or vehicle (Vh). Ten weeks later, systolic blood pressure, LV weight, collagen abundance (computer-aided histology), zymographic matrix metalloproteinase (MMP)-2 activity and its specific tissue inhibitor concentration (TIMP-2) were measured. Both sympathectomy and beta-blockade failed to attenuate the banding-induced blood pressure elevation but significantly attenuated the attendant LV hypertrophy. As expected, pressure-overload hypertrophy was associated with interstitial fibrosis (collagen: 4.37+/-1.23% BVh versus 1.23+/-0.44% SVh, P<0.05), which was abolished by sympathectomy (2.55+/-1.31%, P=not significant versus SSx) but left unchanged by beta-blockade (4.11+/-1.23%, P<0.05 versus both SBb and BSx). beta-blockade, but not sympathectomy, was also associated with an increased TIMP-2/MMP-2 ratio (P<0.05), indicating reduced interstitial collagenolytic activity. In separate groups of banded and sham-operated rats, treatment with the alpha-receptor blocker doxazosin (10 mg/kg per day) displayed similar antifibrotic and biochemical effects as sympathectomy. Thus in the course of experimental pressure overload, the sympathetic nervous system plays a major pro-fibrotic role, which is mediated via alpha-adrenergic but not beta-adrenergic receptors.

Adrenergic alpha-Antagonists↗
PubMed1987

Structural and functional consequence of neonatal sympathectomy on the blood vessels of spontaneously hypertensive rats.

Neonatal sympathectomy of spontaneously hypertensive rats (SHR) and control Wistar-Kyoto rats (WKY) was performed by a combined treatment with antiserum to nerve growth factor and guanethidine during the first 4 weeks after birth. The development of hypertension was completely prevented in the treated SHR: at 28 to 30 weeks of age, systolic blood pressure of treated SHR was 139 +/- 2 mm Hg as compared with 195 +/- 8 mm Hg in untreated SHR. The extent of sympathectomy was verified by histofluorescence. Fluorescence histochemistry for catecholamine-containing nerves showed a complete absence of adrenergic nerves in the mesenteric arteries of treated rats. A supersensitivity to norepinephrine was exhibited by mesenteric arteries, anococcygeus muscle, and tail arteries from the treated SHR and WKY. In the mesenteric vascular bed, maximal response to norepinephrine was significantly reduced by sympathectomy. Sympathectomy also abolished the responses (e.g., generation of excitatory junctional potentials) of tail arteries to electrical stimulation of perivascular nerves. Morphometric measurements of three categories of mesenteric arteries showed that sympathectomy had no effect on the hypertrophic change of smooth muscle cells in the conducting vessels, but it prevented the hyperplastic changes of the muscle cells from reactive, muscular arteries and small resistance vessels. These results suggest that one of the primary roles of the overactive sympathetic nervous system in the development of hypertension in SHR is manifested through its trophic effect on the arteries of SHR. This trophic effect appears to cause a hyperplastic change in the smooth muscle cells in the reactive and resistance vessels, thereby contributing to the development of hypertension in older SHR.

Animals↗
PubMed1991

Combined effect of neonatal sympathectomy and adrenal demedullation on blood pressure and vascular changes in spontaneously hypertensive rats.

Neonatal sympathectomy using a combined treatment with antiserum to nerve growth factor and guanethidine during the first 4 weeks after birth was carried out in spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) rats. Bilateral adrenal demedullation was performed in 4-week-old sympathectomized SHR and WKY rats. The development of hypertension in SHR was prevented by sympathectomy, but the blood pressure (BP) was still higher than in age-matched WKY rats. Demedullation reduced the BP of sympathectomized SHR to the same level as that of WKY rats. Heart rates of SHR and WKY rats were not affected by the treatments. Morphometric measurements of the mesenteric arteries showed that sympathectomy significantly reduced the medial mass in the mesenteric arteries of SHR, mainly through a reduction in the number of smooth muscle cell layers. In sympathectomized SHR, demedullation increased the lumen size of muscular arteries under maximally relaxed conditions, which might explain the further reduction in BP in these animals. Demedullation in sympathectomized SHR and WKY rats caused a decrease in smooth muscle cell layers in the superior mesenteric artery, but the same treatment resulted in a slight increase in the number of smooth muscle cell layers in the large and small mesenteric arteries of SHR and WKY rats. Adventitial area was increased in some mesenteric arteries of SHR and WKY rats by sympathectomy, and demedullation caused a further increase in the size of adventitia in WKY rats. Heart weight in SHR was normalized to the level found in WKY rats by sympathectomy and demedullation. We conclude that in sympathectomized SHR, the elevated BP was maintained by the adrenal medulla.

Adrenal Medulla↗
PubMed1987

Neuroparalytic keratitis and the effect of cervical sympathectomy following operative procedures for trigeminal neuralgia.

A study of 248 patients who underwent operative procedures for trigeminal neuralgia over a nineteen year period is presented, with particular reference to those who developed neuroparalytic keratitis to see if cervical sympathectomy had any protective effect on the cornea. 51 patients underwent cervical sympathectomy, 46 as a prophylactic procedure, and 5 as a treatment for neuroparalytic keratitis. Of these patients 3 (5.9%) developed neuroparalytic keratitis, but 2 of them had had an inadequate sympathectomy. Forty seven patients who did not undergo cervical sympathectomy had either an anaesthetic cornea or a reduced corneal reflex, and of these 11 (23.4%) developed neuroparalytic keratitis. An adequate cervical sympathectomy therefore appears to have a protective effect on the cornea against the development of neuroparalytic keratitis.

Cervical Plexus↗
PubMed2005

Video-assisted sympathectomy for essential hyperhidrosis: effects on cardiopulmonary function.

BACKGROUND: Essential hyperhidrosis is characterized by overactivity of the sympathetic fibers passing through the upper-dorsal ganglia (second and third thoracic ganglia [D2-D3]), and the treatment of choice is video-assisted thoracoscopy sympathectomy. Alterations in cardiopulmonary function after treatment have been reported. STUDY OBJECTIVE: To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis. DESIGN AND SETTING: Prospective controlled trial at a pulmonary function unit of a university hospital. PATIENTS: Twenty patients (2 men and 18 women) with essential hyperhidrosis. MEASUREMENTS AND RESULTS: Pulmonary function tests, including spirometry and thoracic gas volume, bronchial challenge with methacholine, and maximal exercise, were performed before and 3 months after D2-D3 sympathectomy. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of D2-D3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal midexpiratory flow was the only variable that showed significant changes, from 101% (SD, 26%) to 92% (SD, 27%) [p < 0.05]. Ten patients had positive bronchial challenge test results that remained positive 3 months after surgery, and 2 patients whose challenge test results were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal exercise test. CONCLUSIONS: Video-assisted thoracoscopy is a safe treatment, and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in the presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in HR. The clinical importance of these findings is not significant.

Adolescent↗
PubMed2003

Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis.

CONTEXT: Essential hyperhidrosis is a frequent disorder causing significant functional impairment. The advent and development of video-assisted thoracoscopic techniques now allows thoracic sympathectomy to be carried out precisely and safety with good results and minimal morbidity. OBJECTIVE: To assess the impact of video-assisted thoracic sympathectomy in patients diagnosed as presenting severe and disabling hyperhidrosis. TYPE OF STUDY: This was a longitudinal study of the clinical course of all hyperhidrosis cases selected for surgery between May 1999 and January 2003. SETTING: Division of Thoracic Surgery, Universidade Federal de S o Paulo (UNIFESP). PARTICIPANTS: 743 patients with surgery indicated due to palmar hyperhidrosis (49.8%), palmar-axillary hyperhidrosis (38.1%), craniofacial hyperhidrosis (8.9%) or isolated axillary hyperhidrosis (2.8%). PROCEDURES: Video-thoracoscopic sympathectomy was performed, isolating the second thoracic ganglion (T2) in all patients, with additional sympathectomy of T3 and T4 if necessary. MAIN MEASUREMENTS: The clinical course was followed up via questionnaires, phone calls, letters and statements. Simple questions were asked regarding the disappearance of symptoms and presence and intensity of compensatory sweating. RESULTS: The surgery was regarded as efficient in all cases of palmar hyperhidrosis. In the craniofacial hyperhidrosis cases, partial recurrence of the symptoms occurred in 2 cases (3.0%). Partial recurrence or persistence of symptoms occurred in 20% of the patients with predominantly axillary symptomatology. The compensatory sweating was considered disagreeable or uncomfortable by about 30% of the patients, but it only reached the level of regretting the operation for 3% of them. This occurred more frequently in patients with axillary hyperhidrosis. Ten cases of complications occurred. CONCLUSION: Thoracoscopic sympathectomy provides very good results in most patients, with a very low complication rate. However, the assessment of surgical results using conventional methods is imprecise and inaccurate. Different methodology, including quality of life assessment, must be used for comparing results and providing objective data on the results of this operation.

Adolescent↗
PubMedDate not supplied

Lower limb sympathectomy assessed by laser Doppler blood flow and transcutaneous oxygen measurements.

In a retrospective study of critical ischaemia of the lower limb, sympathectomy appeared to be of value in the majority of patients. We therefore assessed sympathectomy by measuring skin blood flow before and after the procedure using laser Doppler flowmetry (LDF) and transcutaneous oxygen tension (TCpO2) techniques. Twenty patients underwent chemical sympathectomy and there was one surgical procedure. Measurements were performed before and 1 week after sympathectomy below the knee and on the forefoot. Symptomatic improvement occurred in 20 of 21 patients. This study demonstrates that skin blood flow in the leg and foot is improved by sympathectomy and confirms objectively our clinical impression.

Adult↗
PubMed2000

Changes of bilateral palmar skin temperature in transthoracic endoscopic T-2 sympathectomy.

OBJECT: Transthoracic endoscopic T-2 sympathectomy is currently the treatment of choice for palmar hyperhidrosis (PH). Intraoperative monitoring of palmar skin temperature (PST) is often used to assess the adequacy of sympathetic ablation. The aim of this study was to investigate the time course of PST changes during the operation and to determine factors involved in the sympathetic modulation of the palmar skin blood flow. METHODS: Eighty-one patients with PH underwent bilateral transthoracic endoscopic sympathectomy of T-2 in which continuous intraoperative PST monitoring was used. Palmar skin temperature data, recorded every 30 seconds throughout the operation, were plotted against time, and a graph of two PST curves was obtained in each case. A multiphasic curve pattern of great similarity was observed in nearly 70% of cases. Specific PST readings at different operative stages were collected and averaged for all cases. The trend of PST changes in response to different procedures during the operation was analyzed. It was found that unilateral procedures caused simultaneous bilateral PST alterations. In almost all cases, bilateral PST was dramatically lowered when unilateral skin incision and intercostal muscle dissection were performed. The temperature remained low until the T-2 sympathectomy was finished on one side. In addition, unilateral T-2 sympathectomy induced synchronous elevation of bilateral PST. However, the ipsilateral response was significantly stronger than that on the contralateral side. CONCLUSIONS: Although intraoperative monitoring of PST is a reliable guide for surgeons performing endoscopic transthoracic sympathectomy, it is important to realize that PST fluctuates at different stages during the operation and that surgical procedures themselves can significantly influence PST readings. The PST data recorded at specific time points, therefore, can be misleading in terms of accuracy and the completeness of ablation of the target sympathetic ganglia, especially when the sympathetic trunk or ganglia are anatomically aberrant.

Adolescent↗
PubMed1999

Transaxillary thoracoscopic sympathectomy experience in a hot climate: management of the dominant hand.

Primary palmar hyperhydrosis is a functionally and socially disabling problem of unknown etiology, affecting adolescents and young adults, especially in hot climates. Thoracoscopic sympathectomy is the most effective treatment for palmar hyperhydrosis. Postsympathectomy rebound hyperhydrosis may limit its success, especially in hot climates. The aim of this study is to report experience with thoracoscopic sympathectomy in a hot climate, managing the dominant hand (unilateral), followed by the other hand at a later date, based on the patient's choice. One hundred twenty patients were operated on during a 3 year period. The mean operative time was 25 minutes. The procedure was successfully completed in 169 operated limbs and was abandoned in one limb because of severe pleural adhesions. The procedure was done for the dominant hand (unilateral) in 120 patients. Fifty patients returned for contralateral thoracoscopic sympathectomy. There were 18 postoperative complications. Most of the patients (95%) were discharged after an overnight stay. The early observed cure rate was high (97%). During the mean follow-up period of 300 days, there was no recurrence of the original symptoms, except for one patient in whom the nerve of Kuntz was found and diathermized on the second thoracoscopy with symptomatic relief. Rebound hyperhydrosis occurred in 40 patients (33% of the total; 21% in the unilateral group and 42% in the bilateral group). In conclusion, it seems that transaxillary endoscopic sympathectomy of the dominant hand is an alternative method of treatment for patients with hyperhydrosis. Managing the dominant hand first and giving the patient the chance to observe the severity of the rebound hyperhydrosis may facilitate the decision for contralateral sympathectomy.

Adult↗
PubMedDate not supplied

[Lumbar sympathectomy].

The authors undertook a study of the present indications for lumbar sympathectomy in cases of obliterating arteriopathy of the lower limbs. The principal physiological effects are described in addition to its action on the circulation. Apart from the opening of arteriovenous shunts, the lifting of the precapillary block should be emphasized since this increases the flow and consequently leads to the development of the collateral circulation. A recent experiment over a period of three years involving 457 hospitalized patients is then analysed: out of 371 conservative operations performed, 169 involved restorative arterial surgery and 202 involved only lumbar sympathectomy. Lumbar sympathectomy was combined with the arterial surgery in 150 of the 169 cases quoted above. Lumbar sympathectomy alone is required in stages III and IV when arterial is not possible. At stage II, there is a choice, sympathectomy being preferred to direct surgery. The results are analysed and the best were obtained with patients at stage II.

Arterial Occlusive Diseases↗
PubMed1976

Metabolic alterations following chemical sympathectomy with 6-hydroxydopamine in the rat.

Until recently the role of the sympathetic nervous system on intermediary metabolism has been difficult to study because of the lack of efficient methods of producing generalized sympathectomy. Various metabolic parameters were measured 24 hr, 72 hr, and 1 week after chemical sympathectomy produced by a single intravenous injection of 6-hydroxydopamine (100 mg/kg) in rats. All animals were fasted 16 hr previous to all measurements. A marked increase was found in blood glucose levels in 6-OH-DA-treated animals. Serum free fatty acids (FFA) were 2 1/2 times higher 24 hr after sympathectomy than in control animals, but returned to normal values thereafter. The glycogen content of the liver was 10 times greater in treated animals 24 hr after 6-OH-DA, whereas cardiac glycogen was more than doubled 72 hr after sympathectomy. In contrast, glycogen content of skeletal muscle was only slightly but insignificantly increased. Immunoreactive insulin levels were also increased by 70 percent in sympathectomized animals after 24 hr, but returned to normal values thereafter. These results indicate an important alteration of carbohydrate and lipid metabolism after chemical sympathectomy, thus supporting a role of the sympathetic nervous system in their regulation.

Adrenal Medulla↗
PubMed2001

Pitfalls and complication avoidance associated with transthoracic endoscopic sympathectomy for primary hyperhidrosis (analysis of 2200 cases).

BACKGROUND: Transthoracic endoscopic sympathectomy (TES) has been already a standard method for the treatment of primary hyperhidrosis. There are rare reports about possibly encountered problems during TES. Therefore, we present our experience in treating palmar and axillary hyperhidrosis and discuss the resoluble methods of potential problems during and after TES. PATIENTS AND METHODS: From June 1994 to October 1999, there were 2200 patients with palmar or axillary hyperhidrosis underwent TES. There are 926 males and 1274 females. Their mean age was 23.4 years old (range: 5-65). All except 12 patients were placed in half-sitting position under single or double-lumen intubation anesthesia. Either a 6-mm or 8-mm, 0degrees thoracoscope, (Karl Storz, Germany) was used to perform sympathectomy thru 0.8 cm incisions below each axilla. Ablation of T2 ganglion was performed in treating patients with palmar hyperhidrosis. Ablation of T3 and T4 ganglia was performed for patients with axillary hyperhidrosis. All except 22 patients were discharged 4 hours after TES, and returned to their activities within one week. RESULT: Successful sympathectomy were achieved up to 2178 patients (99%), but the rates of incidental unusual findings and possibly encountered problems during TES were 5.6% and 7.1% alternatively. Surgical complications included pneumothorax (10 patients, 0.45%), Hemothorax (2 patients, 0.09%) segmental atelectasis (12 patients, 0.55%), mild wound infection (3 patients, 0.14%) and compensatory sweating (1936 patients, 88%). There was no surgical mortality case. But pleural adhesion (54 patients, 2.45%), repeat sympathectomy (27 patients, 1.23%), obscured upper sympathetic trunk by adipose tissue (22 patients, 1%), medially located sympathetic trunk (18 patients, 0.81%), great vessels overriding or close to the sympathetic trunk (15 patients, 0.68%), aberrant vessels (3 patients, 0.14%), transient bradycardia (3 patients, 0.14%) and re-expansion pulmonary edema (1 patient, 0.05%) might occur during TES. CONCLUSION: Potential complications may happen during and after TES. But nearly all endoscopic sympathectomy could be achieved if surgeons acknowledge possible anatomic variation and has ability to overcome pleural adhesions.

Adolescent↗
PubMedDate not supplied

[Chemical lumbar sympathectomy in patients with chronic ischemia of the lower extremities].

The efficiency of lumbar chemical sympathectomy made within the complex therapy for ischemic pain in the lower extremities was analyzed versus lumbar sympathectomy, made surgically, in 84 male and female patients aged 33-84. The below parameters were studied: the dynamics of painless-walking distance in patients with ischemia, stages IIa and IIb, and rest-pain intensity in patients with ischemia, stages III and IV, according to Fontaine. The regional hemodynamics was registered in all patients by Duplex scanning of lower-extremities vessels before manipulation and on days 5 and 10 after sympathectomy performed by chemical and surgical techniques. An increased distance of painless walking, reduced intensity of rest pain and better parameters of regional hemodynamics were observed in the study and control groups; they were of the unidirectional nature. Thus, sympathectomy, made by the chemical technique, is not inferior by its efficiency to surgical lumber sympathectomy.

Adult↗
PubMed2004

[Thoracic sympathectomy performed by videothoracoscopic technique].

UNLABELLED: Thoracic sympathectomy is a method for a segmental elimination of functions of the sympathetic system by the excision of its Th2-Th3 ganglia. The procedure can be performed both using open and videoscopic technique. OBJECTIVE: The purpose of the study was the evaluation of efficacy of videoscopic thoracic sympathectomy. MATERIAL AND METHOD: From 1993 to 2003 we performed 53 videoscopic thoracic sympathectomies in patients with Raynaud's syndrome and upper limb hyperhidrosis. RESULTS: In all patients that underwent thoracic sympathectomy we obtained a positive reaction to a segmental excision of the sympathetic trunk. Patients with Raynaud's showed a significant improvement in symptoms in 76% of cases after a 4-year observation while patients with hyperhidrosis in 100%. The time of hospitalisation was 3.5 days in average. Postoperative complications were observed in two patients (3.7%). Videoscopic thoracic sympathectomy provides good therapeutic and cosmetic results and deserves more common use compared with open technique.

Ganglia, Sympathetic↗
PubMed1990

Sympathectomy and limb salvage in peripheral vascular insufficiency: a clinical study of 100 patients.

An analysis of clinical features and response to sympathectomy of one hundred patients with peripheral vascular insufficiency were reviewed. The commonest symptom was intermittent claudication followed by ulcer, gangrene and rest pain. Symptoms were severe enough to require unilateral cervical sympathectomy in 11 and bilateral in four patients [corrected]. Lumbar sympathectomy was undertaken unilaterally in 59 patients while in 29 patients bilateral procedure was carried out. Nine patients had undergone both cervical and lumbar sympathectomy as they had the disease involving both the upper and lower extremities. The disease was far advanced in 38 [corrected] patients who underwent conservative amputation. A policy of sympathectomy with conservative amputation gave excellent results.

Adult↗