title: Thoracoscopic sympathectomy for symptomatic arterial obstruction of the upper extremities.
abstract: BACKGROUND
  Severely symptomatic arterial insufficiency of the hand and upper extremities requires adequate treatment. Medical therapy and local care are usually unsuccessful, and thoracic sympathectomy can represent an effective procedure to control pain, to help ulcer healing, and to prevent or delay amputation.
  
  
  METHODS
  We performed 20 thoracoscopic sympathectomies in 15 patients (13 men and 2 women) with upper extremity ischemia. Mean age was 47 years (range 21 to 72 years). All patients were thought to have organic blockage of digital arteries. The condition was unilateral in 10 patients and bilateral in 5. Primary diagnosis was digital arteriosclerosis in 8 patients, Buerger's disease in 4 patients and the remaining 3 were drug abusers with severe ischemia due to accidental intraarterial injection of drugs. Eleven patients (73%) presented with terminal digital necrosis, gangrene, or ulceration of the fingers associated with severe pain. Four patients complained of coldness, pain, and some degree of soft tissue infection without permanent loss of tissue.
  
  
  RESULTS
  We performed 10 unilateral and five bilateral staged (mean interval was 3 months) thoracoscopic sympathectomies. We had two minor complications and no mortality. Mean duration of postoperative chest drainage was 2.5 +/- 0.4 days and mean postoperative hospital stay was 5.3 +/- 0.5 days. Follow-up ranged from 3 to 71 months, with a mean of 33 months. All patients demonstrated clinical benefit after operation.
  
  
  CONCLUSIONS
  Thoracoscopic sympathectomy in patients with severe ischemia of upper limb extremities permits optimal symptomatic control and maximum tissue salvage. Because the procedure is minimally invasive, safe, and associated with a low rate of complications, it should be considered earlier the natural course of this disease.
authors.affiliation: Division of Thoracic Surgery, University of Rome La Sapienza, Policlinico Umberto I, Italy. tiziano.degiacomo@tin.it
authors.forename: Tiziano
authors.initials: T
authors.lastname: De Giacomo
authors.forename: Erino A
authors.initials: EA
authors.lastname: Rendina
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.forename: Domenico
authors.initials: D
authors.lastname: Lauri
authors.forename: Edoardo S
authors.initials: ES
authors.lastname: Mercadante
authors.forename: Marco
authors.initials: M
authors.lastname: Anile
authors.forename: Giorgio F
authors.initials: GF
authors.lastname: Coloni
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001132:Arm / Q000098:blood supply*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005385:Fingers / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013562:Sympathectomy; D013906:Thoracoscopy