title: Thoracic sympathectomy: a review of current indications.
abstract: BACKGROUND
  Thoracic sympathetic ablation was introduced over a century ago. While some of the early indications have become obsolete, new ones have emerged. Sympathetic ablation is being still performed for some odd indications thus prompting the present study, which reviews the evidence base for current practice.
  
  
  METHODS
  The literature was reviewed using the PubMed/Medline Database, and pertinent articles regarding the indications for thoracic sympathectomy were retrieved and evaluated. Old, historical articles were also reviewed as required.
  
  
  CONCLUSIONS
  Currently, thoracic sympathetic ablation is indicated mainly for primary hyperhidrosis, especially affecting the palm, and to a lesser degree, axilla and face, and for facial blushing. Despite modern pharmaceutical, endovascular and surgical treatments, sympathetic ablation has still a place in the treatment of very selected cases of angina, arrhythmias and cardiomyopathy. Thoracic sympathetic ablation is indicated in several painful conditions: the early stages of complex regional pain syndrome, erythromelalgia, and some pancreatic and other painful abdominal pathologies. Although ischaemia was historically the major indication for sympathetic ablation, its use has declined to a few selected cases of thromboangiitis obliterans (Buerger's disease), microemboli, primary Raynaud's phenomenon and Raynaud's phenomenon secondary to collagen diseases, paraneoplastic syndrome, frostbite and vibration syndrome. Thoracic sympathetic ablation for hypertension is obsolete, and direct endovascular renal sympathectomy still requires adequate clinical trials. There are rare publications of sympathetic ablation for primary phobias, but there is no scientific basis to support sympathetic surgery for any psychiatric indication.
authors.affiliation: Faculty of Medicine, Technion-Israel Institute of Technology, PO Box 359, 30952119, Zikhron Ya'akov, Haifa, Israel. hasmonai@inter.net.il.
authors.forename: Moshe
authors.initials: M
authors.lastname: Hashmonai
authors.affiliation: Nuffield Hospital, Ipswich, UK.
authors.forename: Alan E P
authors.initials: AE
authors.lastname: Cameron
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Licht
authors.affiliation: Specialist Surgeon, Melbourne, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Hensman
authors.affiliation: German Hyperhidrosiscenter, Munich, Germany.
authors.forename: Christoph H
authors.initials: CH
authors.lastname: Schick
mesh_terms: D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery; D013562:Sympathectomy; D013906:Thoracoscopy
keywords: Hyperhidrosis; Sympathectomy; Thoracoscopy