Sympathectomy Research Articles

The Effect of Adventitia Stripping in Refractory Ischemic Digits

Ischemic disease of digits is a very frustrating and extremely difficult clinical problem. It is often caused by a variety of diseases, such as atherosclerosis, connective tissue disease, trauma and Raynaud's disease. Patients with this problem usually suffer from poor tissue perfusion and impaired microcirculation. In clinical, ischemic digits often present with pain, cold intolerance, ulceration and even gangrene change. Many strategies are proposed today to overcome this disease. Behavioral therapies, such as avoidance of cold exposure and smoking are a very important intervention. Pharmacologic therapies, like the administration of calcium channel blocker, PGE1 and other vasodilators have been the most commonly used agents. Sympatholytic drugs have also been added to reduce the sympathetic tone in vascular smooth muscles. In addition, anticoagulants or antiplatelet agents are administered to inhibit thrombus formation in occlusive vascular disease. Although these agents are usually effective, unfortunately, in refractory cases, amputation is unavoidable. Those patients have to suffer the fate of partial or total loss of the digits. This ultimate outcome frequently comes with high morbidity and dysfunctions both in physical and psychological terms. In those cases which are refractory to medical therapy, surgical intervention had been carried out to improve tissue perfusion. Tissue perfusion depends on the integrity of the vasculature and the neurovascular regulatory elements. Historically, microsurgical revascularization and sympathectomy were widely performed to recover adequate blood flow. Microvascular reconstruction with interposition vein grafting can be used to reestablish the vascular structure. However, not all cases with digital ischemia are suitable for this procedure due to the possible occurrence of multifocal stenosis. Sympathectomy can reduce sympathetic tone and thus increase the radius of blood vessel. According to Poiseuille's law, blood flow is directly proportional to the fourth power of the vessel's radius. So even a small increase of radius of blood vessel can lead to a very great increase in blood flow. According to Pick and Flatt, sympathetic fibers travel along the epineurium of peripheral nerve, pass to the adventitia, and innervate the smooth muscle of vessels. The removal of adventitia can block the sympathetic tone in the smooth muscle. This procedure may also increase the radius of vessel and reestablish adequate blood flow.

Hardship of development of mini-invasive surgery: the hard history of sympathectomy

The authors review the history of sympathectomy in the past more than fifty years and divide the whole course into four stages: thoracotomy, attempting toward mini-invasion, conventional thoracoscopy and video-assisted thoracoscopy (VATS). Emphasis is laid on the difficult course of how this procedure has developed step by step from its original embarrassed 'large incision, small surgery' status to the modern mini-invasion surgery. The fact has proved that it is the modern natural science particularly the development and utilization of modern instruments that has notably promoted, and will continuously promote, the whole surgery toward mini-invasion.

Axillary Hyperhidrosis Treated with Botulinum Toxin or Curettage

Conservative management of axillary hyperhidrosis is often unsuccessful, but sympathectomy, a more aggressive treatment, is associated with significant

Morphological aspects of rabbit masseter muscle after cervical sympathectomy.

The objective of this paper was to study the effect of sympathetic innervation on morphological and histochemical aspects of skeletal muscle tissue. Rabbit masseter muscle was studied using histochemical and immunohistochemical methods for periods of up to 18 months post-sympathectomy. The morphological and enzymatic characteristics of control masseter muscles were similar on both the left and right sides. The main features were muscle fibres with a mosaic pattern and a predominance of type IIa fibres, followed by type I. Type IIb fibres showed very low frequency. Sympathectomized animals showed varying degrees of metabolic and morphological alterations, especially 18 months after sympathectomy. The first five groups showed a higher frequency of type I fibres, whilst the oldest group showed a higher frequency of type IIb fibres. In the oldest group, a significant variation in fibre diameter was observed. Many fibres showed small diameter, atrophy, hypertrophy, splitting, and necrosis. Areas with fibrosis were observed. Thus cervical sympathectomy induced morphological alterations in the masseter muscles. These alterations were, in part, similar to both denervation and myopathy. These findings indicate that sympathetic innervation contributes to the maintenance of the morphological and metabolic features of masseter muscle fibres.

Computed Tomography- and Magnetic Resonance Imaging: Guided Microtherapy.

This report describes techniques of computed tomography (CT) and magnetic resonance imaging (MRI) image-guided diagnosis and therapy. Fine-needle biopsy, interstitial tumor therapy, and chemical sympathectomy, as well as the treatment of chronic spinal diseases, including periradicular infiltration at irritated spinal nerve roots, percutaneous laser decompression of intervertebral disks, and intraspinal microendoscopic scar dissection after failed back surgery are described. To overcome specific drawbacks of CT application, we have evaluated technological prerequisites and feasibility of MRI guidance of interventional procedures, such as biopsy, aspiration of neoplasm, and local interstitial drug instillation. New MR-compatible needles, trocars/cannulae, endoscopes, and ancillary equipment were developed and evaluated in collaboration with industry. Sequences, study protocols, and the strategies of performing the procedure within the environment of an interventional MRI suite have been formulated. In 168 patients, 204 interventions such as aspiration biopsy, peridural corticoid injection at spinal nerve roots, intratumoral ethanol instillation, chemical sympathectomy, and percutaneous laser decompression of herniated intervertebral disks were performed successfully. CT and MRI guidance of percutaneous and microendoscopic interventions provides a reproducible and precise means of instrument control. Aside from preoperative planning of the access trajectory, instruments can be placed under CT or MRI control and the therapeutic process can be monitored. Although MRI avoids the need for ionizing radiation and provides multiplanar multislice images with excellent soft tissue contrast, the representation of instruments and the resolution is currently inferior to that achieved by CT imaging.

Transthoracic endoscopic sympathectomy for treatment of hyperhidrosis palmaris.

The objective of this study was to determine the effectiveness of modified transthoracic endoscopic sympathectomy (TES) being used in our institute for treatment of hyperhidrosis palmaris (HP). One hundred and eight cases of HP were treated using TES from June 1991 to June 1992. All underwent TES bilaterally. Palmar temperature was monitored during the operation as an indicator of a successful lesioning of the sympathetic trunk at the T2-level. The ages of the patients ranged from 10 to 61 years. Fifty-one percent of these patients had a positive family history. Seventy-three percent had onset during childhood. Eighty-nine percent had excessive plantar sweating in addition to hyperhidrosis palmaris. The increase in palmar temperature after lesioning the sympathetic trunk was inversely related to the preoperative temperature of the palms (r = 0.81, p < 0.005). Our treatment resulted in improvement of palmar sweating in all of the patients. Decrease of plantar sweating was also noted in 68% of the patients at follow up. No neurological deficits were found. Transient post-operative chest discomfort and compensatory hyperhidrosis (87%) were the most common complications. TES is an effective method for treating patients with HP, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the dorsal approach for thoracic sympathectomy.

Effects of medical vagotomy and sympathectomy on gastric mucosal prostaglandins in water immersion restrain rats

Ulcer index (UI), gastric submucosal blood flow (SMBF), gastric fundic mucosal content of 5 prostaglandins (PGE2, TXB2, PGF2 alpha, PGD2, 6-keto-PGF1 alpha) were measured in water immersion restrain rats under medical vagotomy (MV) or medical sympathectomy (MSp). UI decreased under MV and MSp with 6 hours stress. SMBF decreased less under MV and MSp than control rats. PGE2 of control rats decreased under stress, but increased under MV and MSp. It is resulted that MV and MSp effect PGE2 to increase, inhibition of SMBF decreasing because of increasing PGE2 were recognised and there for stress ulcer were inhibited.

Endoscopic Sympathectomy.

Denervation of the sympathetic nerve can be accomplished with much less operative trauma by using the endoscopic surgical approach. Although endoscopic thoracic sympathectomy is not new, the techniques and the extent of denervation have not been standardized. The anatomic appearances and configurations of the sympathetic chain are explained, and various procedures, including ramisections, interganglionic sympathectomy, and ganglionectomy, are reviewed. Thoracoscopic approaches, operative techniques, and potential complications are discussed.

Reflex Sympathetic Dystrophy: A Treatable Cause of Post Traumatic and Post Ischemic Pain

Abstract While causalgia pain and RSD are fortunately uncommon after vascular surgery, they can occur if nerves are injured or rendered ischemic for long periods. The vascular surgeon must be able to recognize and diagnose this entity, which is relatively easy once considered. Early diagnosis and an aggressive program of serial sympathetic blocks against a background of certain neuroleptic drugs along with physio-therapy will often bring about reasonably early control. If not, surgical sympathectomy gives good, long-term relief if a logical selection process is followed.

Should We All Have a Sympathectomy at Birth? Or at Least Preoperatively?

Should We All Have a Sympathectomy at Birth? Or at Least Preoperatively?

The effect of lumbar sympathectomy on postsynaptic vascular smooth muscle response in the lower limb in dogs.

The intent of this experiment was to study the postsynaptic vasoactive response to tolazoline hydrochloride and sodium-meglumine diatrizoate (Renografin-76) after a unilateral lumbar sympathectomy in a dog model. Both lower extremities were examined using the video dilution technique before and 1-2 weeks after unilateral lumbar sympathectomy (SE). Results showed (1) resting blood flow in the femoral artery as a percentage of cardiac output did not change after sympathectomy (mean and SD before and after SE: 7.0% +/- 2.3 and 6.0% +/- 2.9 respectively n = 13); (2) the reactive hyperemia in the femoral artery caused by sodium-meglumine diatrizoate (Renografin-76) was unchanged after sympathectomy; (3) the vasodilator effect of tolazoline hydrochloride decreased significantly after sympathectomy (p less than 0.05).

Noninvasive Evaluation for the Therapeutic Effect Using Thallium-201 in the Ischemic Foot

Arterial insufficiency of the foot was examined by radioisotope study with intravenous administration of thallium-201. We observed the immediate distri bution during postocclusive reactive hyperemia and the redistribution in the foot after a 3 hours interval. Seventy-seven feet were examined: 18 normal feet, 24 feet with claudication, 31 feet with rest pain or ischemic ulcers, 4 feet with diabetic ulcers. The distribution index (D.I.), which defined the ratio of uptake counts of the immediate distribution to those of the redistribution, was of use to evaluate quantitively the degree of ischemia. Using these parameters to assess the therapeutic effects, 23 feet with ischemic ulcers were examined before and after treatment.: 5 feet with arterial reconstruction, 4 feet with lumbar sympa thectomy, 14 feet undergoing medical treatment. The effect index (E.I.) was defined as the ratio of the D.I. after treatment to before treatment. When the E.I. value was more than 1.0, 18 of 20 ischemic ulcers were improved and two were unchanged whereas all four ulcers with the E.I. value less than 1.0 became worse. The D.I. is a reliable indicator to estimate the degree of ischemia and the E.I. is of use to predict therapeutic effect particularly following lumbar sympa thectomy or medical treatment, which are frequently difficult to be evaluated by other noninvasive diagnostic methods.

Lumbar Sympathectomy as a Surgical Approach in Hereditary Sensory Neuropathy (Thevenard Syndrome)

Hereditary sensory neuropathy (HSN) as described by Thevenard is characterized by the appearance of a painless corn on the great toe or sole which develops into an ulcer with purulent discharge. This is accompanied by the occurrence of pathologic fractures, and amputation is frequently necessary. Chronic neuritis of the nerve roots and the loss of sensation have been thought to be responsible. Recently, capillary arteriovenous (A-V) anastomosis and a poor capillary network were demonstrated to have caused poor circulation in the skin of the affected feet. Three patients, 1 female and male and female siblings (from 2 unrelated families) whose age ranged from 15-20 years and who suffered from ulcers in the soles and big toe, with purulent discharge and loss of sensation were studied by femoral angiogra phy. Poor vascularization was found in the feet of both females as well as in the male, who had an amputated toe and earlier had undergone surgery because of an A-V fistula in the foot. Macroaggregates (Technecium 99) were injected during angiography and traced with a gamma camera. In the extremities of all 3 patients, the demonstrable material was markedly dimin ished when compared with that seen in the controls. A lumbar sympathec tomy was performed in the 3 patients in order to improve blood flow in the skin and prevent further deterioration. Ten days after surgery the purulent discharge had disappeared and within 5 months the ulcers were healed. After 3 years of follow-up these patients lead normal lives and have no complaints except for the remaining sensory loss. Lumbar sympathectomy is therefore suggested as a new method of treatment for this disabling disease.

Pulmonary functional abnormalities after upper dorsal sympathectomy.

Pulmonary function tests were performed in a group of 15 patients before and 1 to 3 months after upper dorsal sympathectomy. Significant decreases in all compartments of lung volume and maximal expiratory flows were found. Serial studies in 3 patients showed improvement after 6 to 8 months.

Effects of sympathectomy on blood flow through stenotic vessels during exercise: an experimental study in a canine model.

Effects of sympathectomy on blood flow through stenotic vessels during exercise: an experimental study in a canine model.

Effect of chemical sympathectomy on pressor responses to norepinephrine, angiotensin and tyramine.

L'action de la dopamine 6-OH (6-OH DA) sur les reponses de la tension arterielle a la norepinephrine, la tyramine, et l'angiotensin II a ete etudiee chez le rat. 24 h apres l'injection i.v. de 6-OH DA (100 mg/kg), la difference de tension due a la norepinephrine fut nettement plus marquee alors que celle a la tyramine avait presque disparu. L'ablation chimique du systeme sympathique n'a aucun effet sur la reponse de la tension a l'angiotensine II.

Hyperhidrosis and its treatment by endoscopic-endotracheal sympathectomy

Hyperhidrosis and its treatment by endoscopic-endotracheal sympathectomy

Treatment of glaucoma by chemical sympathectomy with 6-hydroxydopamine.

Treatment of glaucoma by chemical sympathectomy with 6-hydroxydopamine.

Sympathectomy for Menière's disease--a long-term reviews.

Sympathectomy for Menière's disease--a long-term reviews.

Sympathectomy and Claudication

Sympathectomy and Claudication