title: Thoracic sympathectomy for digital ischemia: a summary of evidence.
abstract: BACKGROUND
  Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia.
  
  
  METHODS
  We reviewed the English literature between 1980 and 2010. Our analysis included reports with the clinical end points of relief, recurrence of symptoms or healing of ulcers, or both. Primary Raynaud disease (PRD) and secondary Raynaud phenomenon (SRP) were analyzed separately.
  
  
  RESULTS
  An initial postoperative positive effect was reported in 92% of PRD patients and in 89% of SRP patients. Long-term beneficial effect was 58% for PRD and 89% for SRP. Ulcer healing or improvement was achieved in 95%.
  
  
  CONCLUSIONS
  The available evidence suggests that thoracic sympathectomy has a role in the treatment of severe PRD and SRP, albeit with better results in SRP patients than in PRD patients. In case of digital ulceration, thoracic sympathectomy may maximize tissue preservation or prevent amputation.
authors.affiliation: Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands. h.coveliers@vumc.nl
authors.forename: Hans M E
authors.initials: HM
authors.lastname: Coveliers
authors.forename: Frank
authors.initials: F
authors.lastname: Hoexum
authors.forename: Johanna H
authors.initials: JH
authors.lastname: Nederhoed
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
authors.forename: Jan A
authors.initials: JA
authors.lastname: Rauwerda
mesh_terms: D019317:Evidence-Based Medicine; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000473:pathology / Q000601:surgery*; D011928:Raynaud Disease / Q000473:pathology / Q000601:surgery*; D012883:Skin Ulcer / Q000473:pathology / Q000601:surgery*; D013562:Sympathectomy; D013900:Thoracic Nerves / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing