THORACOSCOPIC SYMPATHECTOMY FOR ISCHEMIA OF THE UPPER EXTREMITY IN BUERGER'S DISEASE

Abstract

From October 1993 to September 1998, 10 patients (all men) with ischemia of the upper extremity in Buerger's disease underwent a thoracoscopic sympathectomy for hand or finger ischemia. The clinical symptoms of these patients were cold sensation of the hand and/or finger in all patients, and finger ulceration in three patients. Preoperative angiography of the upper extremities was done in all patients for diagnosis of blood flow in the hand and fingers. All patients underwent the procedure under general anesthesia. The patient was placed in a lateral decubitis position, and all three ports were inserted. The scope and other instruments were inserted, and the operator dissected the sympathetic ganglia T2-T4. After the operation, all patients demonstrated a satisfactory clinical response by warm, dry hand and upper extremity. A recurrence was found in one patient (7.7%), for the technical failure of dissection of the ganglia. We conclude that thoracoscopic sympathectomy is effective and safe procedure for the treatment of upper extremity ischemia in Buerger's disease.