Thoracic sympathectomy for upper extremity ischemia

Frank Hoexum, Hans M Coveliers, Joyce J Lu, Vincent Jongkind, Kak Khee Yeung, Willem Wisselink

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

INTRODUCTION: Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy for upper extremity ischemia a systematic review of the literature was conducted.

EVIDENCE AQUISITION: We performed a PubMed, EMBASE and Cochrane search of the literature written in the English language from January 1975 to December 2015. All articles presenting original patient data regarding the effect of treatment on symptoms or on the healing of ulcers were eligible for inclusion. Individual analyses for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP) were performed.

EVIDENCE SYNTHESIS: We included 6 prospective and 23 retrospective series with a total of 753 patients and 1026 affected limbs. Early beneficial effects of thoracic sympathectomy were noticed in 63-100% (median 94%) of all patients, in 73-100% (median 98%) of PRD patients and in 63-100% (median 94%) of SRP patients. The beneficial effect was noted to lessen over time. Long-term beneficial effects were reported in 13-100% (median 75%) of all patients, in 22-100% (median 58%) of PRD patients, and in 13-100% (median 79%) of SRD patients. Complete or improved ulcer healing was achieved in 33-100% and 25-67% respectively, of all patients.

CONCLUSIONS: Thoracic sympathectomy can be beneficial in the treatment of upper extremity ischemia in select patients. Although the effect in patients with PRD will lessen over time, it may still reduce the severity of symptoms. In SRD, effects are more often long-lasting. In addition, thoracic sympathectomy may maximize tissue preservation or prevent amputation in cases of digital ulceration.

Original languageEnglish
Pages (from-to)676-85
Number of pages10
JournalMinerva Cardioangiologica
Volume64
Issue number6
Publication statusPublished - Dec 2016

Cite this

Hoexum, Frank ; Coveliers, Hans M ; Lu, Joyce J ; Jongkind, Vincent ; Yeung, Kak Khee ; Wisselink, Willem. / Thoracic sympathectomy for upper extremity ischemia. In: Minerva Cardioangiologica. 2016 ; Vol. 64, No. 6. pp. 676-85.
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abstract = "INTRODUCTION: Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy for upper extremity ischemia a systematic review of the literature was conducted.EVIDENCE AQUISITION: We performed a PubMed, EMBASE and Cochrane search of the literature written in the English language from January 1975 to December 2015. All articles presenting original patient data regarding the effect of treatment on symptoms or on the healing of ulcers were eligible for inclusion. Individual analyses for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP) were performed.EVIDENCE SYNTHESIS: We included 6 prospective and 23 retrospective series with a total of 753 patients and 1026 affected limbs. Early beneficial effects of thoracic sympathectomy were noticed in 63-100{\%} (median 94{\%}) of all patients, in 73-100{\%} (median 98{\%}) of PRD patients and in 63-100{\%} (median 94{\%}) of SRP patients. The beneficial effect was noted to lessen over time. Long-term beneficial effects were reported in 13-100{\%} (median 75{\%}) of all patients, in 22-100{\%} (median 58{\%}) of PRD patients, and in 13-100{\%} (median 79{\%}) of SRD patients. Complete or improved ulcer healing was achieved in 33-100{\%} and 25-67{\%} respectively, of all patients.CONCLUSIONS: Thoracic sympathectomy can be beneficial in the treatment of upper extremity ischemia in select patients. Although the effect in patients with PRD will lessen over time, it may still reduce the severity of symptoms. In SRD, effects are more often long-lasting. In addition, thoracic sympathectomy may maximize tissue preservation or prevent amputation in cases of digital ulceration.",
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Hoexum, F, Coveliers, HM, Lu, JJ, Jongkind, V, Yeung, KK & Wisselink, W 2016, 'Thoracic sympathectomy for upper extremity ischemia' Minerva Cardioangiologica, vol. 64, no. 6, pp. 676-85.

Thoracic sympathectomy for upper extremity ischemia. / Hoexum, Frank; Coveliers, Hans M; Lu, Joyce J; Jongkind, Vincent; Yeung, Kak Khee; Wisselink, Willem.

In: Minerva Cardioangiologica, Vol. 64, No. 6, 12.2016, p. 676-85.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Thoracic sympathectomy for upper extremity ischemia

AU - Hoexum, Frank

AU - Coveliers, Hans M

AU - Lu, Joyce J

AU - Jongkind, Vincent

AU - Yeung, Kak Khee

AU - Wisselink, Willem

PY - 2016/12

Y1 - 2016/12

N2 - INTRODUCTION: Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy for upper extremity ischemia a systematic review of the literature was conducted.EVIDENCE AQUISITION: We performed a PubMed, EMBASE and Cochrane search of the literature written in the English language from January 1975 to December 2015. All articles presenting original patient data regarding the effect of treatment on symptoms or on the healing of ulcers were eligible for inclusion. Individual analyses for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP) were performed.EVIDENCE SYNTHESIS: We included 6 prospective and 23 retrospective series with a total of 753 patients and 1026 affected limbs. Early beneficial effects of thoracic sympathectomy were noticed in 63-100% (median 94%) of all patients, in 73-100% (median 98%) of PRD patients and in 63-100% (median 94%) of SRP patients. The beneficial effect was noted to lessen over time. Long-term beneficial effects were reported in 13-100% (median 75%) of all patients, in 22-100% (median 58%) of PRD patients, and in 13-100% (median 79%) of SRD patients. Complete or improved ulcer healing was achieved in 33-100% and 25-67% respectively, of all patients.CONCLUSIONS: Thoracic sympathectomy can be beneficial in the treatment of upper extremity ischemia in select patients. Although the effect in patients with PRD will lessen over time, it may still reduce the severity of symptoms. In SRD, effects are more often long-lasting. In addition, thoracic sympathectomy may maximize tissue preservation or prevent amputation in cases of digital ulceration.

AB - INTRODUCTION: Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy for upper extremity ischemia a systematic review of the literature was conducted.EVIDENCE AQUISITION: We performed a PubMed, EMBASE and Cochrane search of the literature written in the English language from January 1975 to December 2015. All articles presenting original patient data regarding the effect of treatment on symptoms or on the healing of ulcers were eligible for inclusion. Individual analyses for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP) were performed.EVIDENCE SYNTHESIS: We included 6 prospective and 23 retrospective series with a total of 753 patients and 1026 affected limbs. Early beneficial effects of thoracic sympathectomy were noticed in 63-100% (median 94%) of all patients, in 73-100% (median 98%) of PRD patients and in 63-100% (median 94%) of SRP patients. The beneficial effect was noted to lessen over time. Long-term beneficial effects were reported in 13-100% (median 75%) of all patients, in 22-100% (median 58%) of PRD patients, and in 13-100% (median 79%) of SRD patients. Complete or improved ulcer healing was achieved in 33-100% and 25-67% respectively, of all patients.CONCLUSIONS: Thoracic sympathectomy can be beneficial in the treatment of upper extremity ischemia in select patients. Although the effect in patients with PRD will lessen over time, it may still reduce the severity of symptoms. In SRD, effects are more often long-lasting. In addition, thoracic sympathectomy may maximize tissue preservation or prevent amputation in cases of digital ulceration.

KW - Journal Article

M3 - Article

VL - 64

SP - 676

EP - 685

JO - Minerva Cardioangiologica

JF - Minerva Cardioangiologica

SN - 1827-1618

IS - 6

ER -