Long-term effects of thoracic sympathectomy on microcirculation in the hands of patients with primary Raynaud disease.

Abstract

OBJECTIVE:

Videothoracoscopic sympathecomy is a widely used treatment modality in patients with severe Raynaud disease, but the reported late results are less than favorable. There have been no direct studies of the long-term effect of sympathectomy on microcirculation in the hands of these patients.

METHODS:

In 25 patients with Raynaud disease treated with videothoracoscopic Th2-Th4 sympathectomy, we performed basal laser-Doppler flowmetry and measured the maximal refilling time after 1-minute occlusion measurements preoperatively and at 1 week, 6 months, and 1, 2, 3, and 5 years after the sympathectomy. The results were compared with the same measurements obtained in the group of 50 healthy individuals.

RESULTS:

The patients' symptom severity was assessed by using the visual analogue scale. The basal capillary flow and the maximal refilling time improved after the sympathectomy to a level not different from that seen in the healthy population, and the effect was maintained during the 5-year follow-up period. The patients' symptom severity scores diminished to zero in the early postoperative period and increased to 28% of their initial value 5 years after the operation.

CONCLUSIONS:

The videothoracoscopic Th2-Th4 sympathectomy produces excellent and long-lasting improvement of microcirculation function in patients with Raynaud disease. The mild return of symptoms might be due to factors other than the capillary blood flow alterations.

• Authors: Paweł Maga, Jarosław Kuzdzał, Rafał Nizankowski, Andrzej Szczeklik, Krzysztof Sładek
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 133 Issue 6 Pg. 1428-33 (Jun 2007) ISSN: 1097-685X [Electronic] United States
• PMID: 17532934 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Analysis of Variance
• Blood Flow Velocity
• Case-Control Studies
• Female
• Hand (blood supply, innervation)
• Humans
• Laser-Doppler Flowmetry
• Male
• Microcirculation
• Middle Aged
• Raynaud Disease (surgery)
• Sympathectomy (methods)
• Thoracic Surgery, Video-Assisted
• Thoracoscopy
• Treatment Outcome