title: [Thoracoscopic sympathectomy for arterial ischemia of the upper extremities: a case report].
abstract: BACKGROUND
  Thoracoscopic surgery reduce the morbidity of sympathectomy. Major indications of video-assisted sympathectomy (VAT) include hyperhidrosis, Raynaud's disease, causalgia, and reflex sympathetic dystrophy. Because little information is available in the national and international literature VAT sympathectomy in the treatment of upper extremities ischemia, we decided to present our first case.
  
  
  METHODS
  The 38 years old patient was hospitalized for left upper-extremity ischemia (Raynaud's syndrome). Thoracoscopic sympathectomy was performed with resection of the main trunk proximally immediately after the stellate ganglion and distally at the level of T4 and identification and resection of 2 collateral branches of the sympathetic chain T2-T3.
  
  
  RESULTS
  The postoperative evolution demonstrated evident clinical benefit. The thermography performed postoperative showed hyperthermia and hyper-vascularization in the left hemithorax with a difference of temperature of 2 degrees C between the two sides of the thorax.
  
  
  CONCLUSIONS
  Before the advent of VAT, thoracic sympathectomy was performed only in highly selected patients because of its invasiveness. Now VAT sympathectomy is considered in most cases as the last resort to prevent extensive and successive amputation. Because the procedure is minimally invasive, safe, and associated with a low rate of complications, it should be considered earlier in the natural course of this disease.
authors.affiliation: Clinica I Chirurgie Toracică, Institutul National de Pneumoftiziologie Marius Nasta Bucureşti. cpaleru@yahoo.com
authors.forename: Cristian
authors.initials: C
authors.lastname: Paleru
authors.forename: Olga
authors.initials: O
authors.lastname: Dănăilă
authors.forename: Ioana
authors.initials: I
authors.lastname: Bordîncă
authors.forename: Adrian
authors.initials: A
authors.lastname: Istrate
authors.forename: Ciprian
authors.initials: C
authors.lastname: Bolca
authors.forename: Ion
authors.initials: I
authors.lastname: Cordoş
mesh_terms: D000328:Adult; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D008297:Male; D011928:Raynaud Disease / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*