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문인성,박장상,고용복,정병화 대한혈관외과학회 1994 Vascular Specialist International Vol.10 No.1
Surgical sympathectomy of both the upper and lower extremity has passed through a colorful history of development. The concept of sympathetic denervation as therapy for arterial occlusive disease was first elaborated and tested by Leriche and Jaboulay in 1913. In the absence of effective medicine or surgical alternatives, the operation was one of the few options available to surgeons caring for patients with ischemic disorders of the upper extremity. As a result of more effective medical therapy, chemical sympathetic blockade, and the development of percutaneous and endoscopic surgical techniques to disrupt the sympathetic nerve supply to the upper extremity, sympathectomy is now an infrequently performed operation with limited indications. Nevertheless, upper extremity sympathectomy remains a useful method, particularly in the treatment of severe hyperhidrosis and for selected upper extremity ischemia and post-traumatic pain syndrome. This article summarizes over 10 years of experience (l985 to 1994) with thoracic sympathectomy in 30 patients undergoing 32 sympathectomies. The observed results were as follows. I) Male to female ratio was 21:9 and mostly was done at 30s. 2) Common clinical manifestations were gangrene, ulecration and ischemia. 3) Most common pre-operative diagnosis was Buergers disease in 17. 4) Supraclavicular approach was performed in all patients. 5) Ptosis was the most common complication in 7 patients. 6) Immediately, postoperative overall improved rate was encountered 66.7% In summary of this clinical observation, it can be considered that thoracic sympathectomy by superalavicular approach is effective surgical method for the treatment of upper extremity arterial insufficiency, although this study was done limited numbers of patients. Consequently, we found that sympathectomy will relieve pain, improve digital perfusion, and decrease the need for digital amputation.
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