Article Summary

Sympathectomy for Buerger's Disease

by The DiagnosisHeart.com Physician Team
Posted: June 4, 2004

Summary:


Buerger’s disease is an idiopathic, recurrent, segmental, inflammatory obliterative vascular disease involving medium-sized arteries of the limbs. Upper thoracic sympathectomy has an established role in the treatment of patients with hyperhidrosis, causalgia, Raynaud’s disease and Buerger’s disease.

Traditionally, sympathectomy with the removal of the second thoracic ganglion of the ipsilateral side effectively reduces the sympathetic drive to the hand by removing the preganglionic fibers to the upper extremities and results in relief of vasospastic symptoms, relieving pain syndromes and helping to heal trophic ulcers in the digits. Sympathetic trunk interruption in lieu of sympathectomy has not been performed for Buerger's disease.

A 60 year old patient with progressive and longstanding Buerger's diasese presented with acute loss of digits in the right hand. This was associated with significant pain syndrome in the hand. Thoracic sympathetic trunk interruption with titanium clips at T2 was performed on the right side using two 5 mm ports with immediate relief of the pain. The patient was discharged home without pain medications and had uneventful healing of her tissue ulcers within 4 weeks.

Thoracoscopic sympathetic trunk interruption with titanium clips is a safe and effective way to treat patients with Buerger's disease and may in fact reduce the need for large doses of narcotics in patients with debilitating pain syndromes. It enables fast recovery and short hospitalization of the patient. The use of titanium clips to interrupt the sympathetic trunk at T2 can be performed in lieu of sympathectomy.

Reference:
Buerger's Disease and Thoracic Sympathectomy,

Date of Article Publication:
2004, April

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