Extended Periarterial Sympathectomy: Evaluation of Long-termOutcomes

摘要

>Background: Periarterial sympathectomy is a proposed surgical treatment for patients with refractory Raynaud syndrome; however, there is debate regarding the indications and extent of dissection. Due to the segmental arterial sympathetic innervation, we favor an extended sympathectomy in concert with vein graft reconstruction of occluded vessels when necessary. The purpose of this study is to examine outcomes of extended periarterial sympathectomy in our patients. >Methods: A retrospective chart review was performed on 46 patients who underwent 58 periarterial sympathectomies (12 bilateral) since 1981. The data collected include demographics, comorbidities, previous therapy, operative details, and surgical outcomes. In addition, we contacted available patients for a phone survey. >Results: Of 58 cases, 68.9% were female, 29.3% were current smokers, and 58.6% had known connective tissue disease. Thirty-three vein graft reconstructions were performed with a long-term patency of 77.4%. Sustained improvement of ischemic pain was reported in 94.8% of cases, and 78% of patients with ulcers completely healed. For the most symptomatic fingertip, mean Semmes-Weinstein monofilament measurements improved from 4.15 preoperatively to3.29 postoperatively (P ≤ .05). Mean follow-up was 3.97 years.Of 10 patients contacted by telephone, all reported a decrease in frequency andseverity of Raynaud attacks, while 9 reported a long-term decrease in pain anaverage of 11.6 years after surgery. >Conclusions: Extendedperiarterial sympathectomy is an effective and safe procedure for patients withrefractory Raynaud syndrome. Our data demonstrate long-term improvement inischemic pain and sensibility, along with a high rate of ulcer healing andpatient satisfaction.