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 Sympathectomy

Thomas S. Riles, M.D.

I. Anatomy and Physiology

1. To understand the basic anatomy of the autonomic nervous system including the course of sympathetic fibers through the spinal cord, the location of the sympathetic ganglia an the course of the post synaptic fibers.

2. To understand the relationship between the sympathetic fibers and the abdominal aorta and iliac vessels.

3. To understand the functions of the sympathetic nervous system and the pathologic conditions resulting from abnormal sympathetic activity.

4. To understand the potential beneficial effects of sympathetic ablation and possible adverse side effects.

II. Diagnostic Tests to Evaluate Sympathetic Function

1. To understand the basis of various tests to assess sympathetic activity.

2. To be aware of the limitations of the diagnostic tests used to assess sympathetic activity.

III. Clinical Uses of Sympathectomy

1. To understand the historic and current role of sympathectomy for arterial occlusive disease.

2. To understand the probable outcome when sympathectomy is used for ischemic ulcers, gangrene, rest pain, and the differences in clinical response for diabetes and non-diabetes.

3. To be aware of the role of sympathectomy for Buerger's disease, embolic disease, Raynaud's phenomenon, causalgia and post traumatic rest pain, and hyperhidrosis .

IV. Surgical Technique

1. To be aware of the technique for surgical ablation of the lumbar sympathetic chain as well as the technique for chemical ablation.

2. To be aware of the surgical technique for thoracodorsal sympathectomy .

3. To understand the potential complications from lumbar and thoracoabdominal sympathectomies and how to reduce the risk of complication.

References

1. Cronenwett JL, Lundenou SM. Hemodynamic effect of sympathectomy in the ischemic canine hind limbs. Surg 1980; 87:417.

2. Sumner DS. Evaluation of acute and chronic ischemia of the upper extremity. Chapter 65 in Vascular Surgery 4th Ed ( ed by Rutherford ) WB Saunders, Co., Philadelphia , 1995; 924-25.

3. Rutherford RB. Valenta : Extremity blood flow and distribution. The effects of arterial occlusion, sympathectomy and exercise. Surg 1971; 69:332.

4. Rutherford RB, Shannon FL. Lumbar Sympathectomy : Indications and Techniques, Chapter 59 in Vascular Surgery 4th Ed (ed by Rutherford) WB Saunders, Co., Philadelphia, 1995; 874-83.

5. Casten DF, Sadley AH, Foreman D. An experimental study of sympathectomy or patency of small vessel anastomoses . Surg Gynecol Obstet 1962; 114:462.

6. Weissenhofer W, Schenk WG Jr. Hemodynamic response to vasodilation and exercise in “critical” arterial stenosis . Arch Surg 1974; 108:712.

7. Moore WS, Hall AD. Effects of lumbar sympathectomy on skin capillary blood flow in arterial occlusive disease. J Surg Res 1974; 14:151.

8. Walker PM, Johnston KW. Prediction of the success of a sympathectomy : A prospective study using discriminating function and multiple regression analysis. Surgery 1980; 87:216.

9. Yao JST, Bergan JJ. Predictability of vascular reactivity to sympathetic ablation. Arch Surg 1973; 107:676.

10. DeValle MJ, Bauma FG, Mintzer R, et al. Limited success of lumbar sympathectomy in the prevention of ischemic limb loss in diabetic patients. Surg Gynecol Obstet 1981; 152:784.

11. Shionaoya S. Buerger's disease. Pathology diagnosis and treatment. The University of Nagoya Press. 1990.

12. Mills JL, Friedman EI, Taylor LM Jr , et al. Upper extremity ischemia caused by small artery disease. Ann Surg 1987; 154:123.

13. Machleder HI, Wheeler E, Barber WF. Treatment of upper extremity ischemia by cervicodorsal sympathectomy . Vasc Surg 1979; 13:399.

14. Flatt AE. Digital artery sympathectomy . J Hand Surg 1980; 5:550.

15. Lee BY, Brancato RF, Thoden WR, et al. Blue digit syndrome: Urgent indication for digital salvage. Ann J Surg 1984; 147:418.

16. Mehigan JT, Stoney RJ. Lower extremity atheromatous embolization . Am J Surg 1976; 132:163.

17. Mockus MB, Rutherford RB, Rosales C, et al. Sympathectomy for causalgia : patient selection and long-term results. Arch Surg 1987; 122:668.

18. Malone PS, Cameron ALP, Rennie JA. Endoscopic thoracoscopic sympathetic in the treatment of upper limb hyperhidrosis . Ann Coll Surg Engl 1986; 68:93.

19. Appleby TC, Edwards WH Jr. Thoracoscopic dorsal sympathectomy for hyperhidrosis . Technique of choice. J Vasc Surg 1992; 16:121.

20. Ramos M, Almazan A, Lozano F, et al. Phenol lumbar sympathectomy in severe arterial disease of the lower limb. A hemodynamic study. Int Surg 1983; 68:127.

21. Cross FW, Cotton LT. Chemical lumbar sympathectomy for ischemic rest pain. A randomized prospective controlled clinical trail. Am J Surg 1985; 150:341.

22. Weinstein MH, Machleder HI. Sexual function after aorto -iliac surgery. Ann Surg 1975; 181:787.

Posted June 2010