title: Endoscopic thoracic sympathectomy for upper limb ischemia. A 16 year follow-up in a single center.
abstract: BACKGROUND
  The aim of our study was to evaluate the long term results of Endoscopic Thoracic Sympathectomy (ETS) in the management of upper limb ischemia (ULI).
  
  
  METHODS
  We retrospectively reviewed the records of all consecutive patients who underwent ETS for ULI between January 1994 and May 2009. A standardized questionnaire was used to evaluate the long term success, morbidity and overall patient satisfaction.
  
  
  RESULTS
  Thirty-five patients (20 female, mean age 49 years (range 23-79)) underwent bilateral (n = 9) and unilateral (n = 27) ETS procedures, respectively. Six patients had Primary (idiopathic) Raynaud Disease. Twenty-nine patients had upper limb ischemia secondary to systemic disorders (n = 12), embolic disease (n = 10), occlusion of the arteries of the arm (n = 5) or hypothenar hammer syndrome (n = 2). Tissue loss at time of surgery was present in nineteen patients. Short term beneficial effects were reported by 12 patients (63%). Eleven of the 35 patients experienced a total of 13 complications or adverse events, whereof 11 were minor or transient. Limb salvage was unsuccessful in three patients because of major amputations (n = 2) or severe functional impairment (n = 1). Necrotectomies or minor amputations without functional impairment were performed in 9 patients. Medium or long term follow up (mean 98 months (range 18-198) was available in 19 out of 22 living patients(86%). Long term beneficial effects were reported by 10 (53%). Overall patient satisfaction was 56%. Compensatory sweating was experienced by 11 patients (58%).
  
  
  CONCLUSIONS
  Although the long term efficacy of ETS in our study was moderate (53%), due to its low invasiveness ETS is a valuable option in the management of ULI.
authors.affiliation: Department of Vascular Surgery, VU Medical Center, Amsterdam, The Netherlands. Electronic address: h.coveliers@vumc.nl.
authors.forename: Hans
authors.initials: H
authors.lastname: Coveliers
authors.affiliation: Department of Vascular Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Hoexum
authors.affiliation: Department of Vascular Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Rauwerda
authors.affiliation: Department of Vascular Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013562:Sympathectomy / Q000379:methods; D013900:Thoracic Nerves / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply* / Q000601:surgery*
keywords: Endoscopic; Ischemia; Sympathectomy; Thoracic; Upper limb