Prognostic Factors of Chronic Upper Limb Ischemia and Endoscopic Thoracic Sympathectomy

Abstract

Long-term results of chronic upper limb ischemia and related prognostic factors were evaluated. In addition, the efficacy of endoscopic thoracic sympathectomy was examined. Thirty-one patients with chronic ischemic episodes of 41 upper limbs were reviewed retrospectively. The cause of ischemia included atherosclerosis in 18 limbs, Buerger's disease in 16 limbs, and other causes in seven limbs. Thoracic sympathectomy was under taken in 21 limbs, and bypass grafting was undertaken in five limbs. Fifteen limbs were not treated surgically. Of the 21 thoracic sympathectomies, the transthoracic approach was used in 12 and thoracoscopy was used in seven. In addition, an extrapleural approach was used in two cases because of dense pleural adhesion.Compared with open sympathectomy, the intraoperative blood loss, the duration of chest tube drainage, and the complication rate were significantly decreased in the endo scopic group. Recurrence rates for all 41 limbs were 14.5% at 1 year, 19.2% at 2 years, and 30.3% at 3 years. Univariate analysis revealed significantly lower recurrence rates for men, cases caused by Buerger's disease, and limbs without contralateral upper limb ischemia. Multivariate analysis also disclosed a significantly lower recurrence rate for limb ischemia caused by Buerger's disease.The cause of upper limb ischemia influenced the outcome. In cases of Buerger's disease, the recurrence rates were low, and thoracic sympathectomy was effective. Thoracoscopic sympathectomy was safe and less invasive than open sympathectomy and is a valid therapeutic option for treating upper limb ischemia.