Thoracoscopic sympathectomy for symptomatic arterial obstruction of the upper extremities

Thromboangiitis obliterans (Buerger's disease)

Thromboangiitis Obliterans is a non-atherosclerotic inflammatory disease of unknown etiology, which has a strong association with tobacco. We present current concepts on the pathophysiology and diagnosis, as well as a review in treatments.

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Current concepts on the pathophysiology and diagnosis of Thromboangiitis Obliterans.

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Importance of complete abstinence of tobacco.

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Actual Treatments of Thromboangiitis Obliterans.

Pathogenesis and Management of Buerger's Disease

Buerger's disease or thromboangiitis obliterans causes pain, ulceration, or gangrene in the lower or upper extremity. It is associated with chronic cigarette smoking and is believed to be an immune mediated vasculitis. The pathogenesis is still unknown but recent postulate of its association with odontal bacteria has generated much renewed interest. Despite its recognition more than a century ago, little progress has been made in its treatment. Until the pathogenesis is elucidated, abstinence from cigarette is the only effective therapy.

Treatment of digit ulcers in a patient with Buerger's disease by using cervical spinal cord stimulation -a case report-

Buerger's disease (thromboangiitis obliterans) is known as a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. Most effective treatment for Buerger's disease is smoking cessation. Except for the cessation of tobacco use, surgical revascularization is available in severe ischemia and a distal target vessel. Amputation has been used as the last treatment option of the disease up to the present. Increasing limb survival and decreasing amputation rate is important. This case describes the use of spinal cord stimulation (SCS) in patient with Buerger's disease and its effect is not only the complete healing of ulcers but also amputation is not performed.

Achieving renal denervation: catheter-based and surgical management for neural ablation in the management of hypertension

Hypertension refractory to conventional management with medication remains a significant cause of cardiovascular morbidity and mortality. Alternative strategies are warranted in this subgroup of patients. The target of these strategies centers around sympathetic neural activity, which is thought to play a key role in hypertension. We will review the historic and current approaches toward altering sympathetic neural activity, specifically discussing surgical sympathectomy, catheter-based renal denervation strategies, and baroreflex activation therapy.

Guidelines on surgery of the thoracic sympathetic nervous system

Thoracic sympathetic nervous system (TSNS) surgery has increased in importance in the last few years, generating great expectations among the general population and the scientific community. This has been due to the excellent results obtained by videothoracoscopy-assisted thoracic sympathectomy in the treatment of essential hyperhidrosis and other TSNS disorders. This minimally invasive surgical technique has been shown to be effective, and with a low morbidity it is accepted as one of the best therapeutic options for the treatment of palmar and bilateral axillary hyperhidrosis and the number of patients consulting with the intention of having the operation has increased considerably. Although compensatory sweating, which is occasionally intense, often occurs after the surgery, this and other secondary effects of the technique are well tolerated by patients. The current evidence on TSNS and the treatment of essential hyperhidrosis is based on observational studies, making it difficult to compare series and draw conclusions. There has been much discussion on standardising the technique, defining the most favourable levels for clipping, and choosing the type of denervation with least secondary effects. This has led to the need to draw up these guidelines which should clarify and standardise the criteria for managing patients with disorders of TSNS.

A 7-year Experience with Thoracoscopic Sympathectomy for Critical Upper Limb Ischemia

BACKGROUND

Severely symptomatic arterial insufficiency of an upper limb not suitable for revascularization is a difficult condition to manage. Thoracoscopic sympathectomy (TS) can be an effective procedure in this setting.

METHODS

Our experience with 18 consecutive thoracoscopic sympathectomy (TS) procedures over a period of 7 years has been reviewed. Indications, operative technique, complications, and outcome of surgery are analyzed.

RESULTS

We performed 18 TS procedures on 17 patients during this period. There were no deaths. One patient had intraoperative hemorrhage necessitating conversion to open thoracotomy. Mean postoperative hospital stay was 2.3 days. Follow-up ranged from 6 to 72 months. All patients demonstrated clinical benefit from the procedure.

CONCLUSIONS

Thoracoscopic sympathectomy is a useful option in patients with severely symptomatic hand and digital ischemia from occlusive small arterial disease like thromboangitis obliterans.

Thromboangiitis obliterans (Buergerʼs disease)

PURPOSE OF REVIEW

Thromboangiitis obliterans is a nonatherosclerotic segmental inflammatory disease that affects the small and medium-sized arteries and veins in the upper and lower extremities. This review will help to familiarize physicians with this vasculitis that is completely different from every other type of vasculitis encountered.

RECENT FINDINGS

While tobacco is central to the initiation and continuance of Buerger's disease activity, two interesting pathophysiologic observations have been made. There is endothelial dysfunction in arteries not yet clinically or angiographically involved in thromboangiitis obliterans. There are elevated levels of anti-endothelial cell antibodies and measurement of these antibody titers may be useful in following disease activity in Buerger's disease patients. The only therapy clearly shown to prevent amputation is the complete abstinence of tobacco. There is exciting work under way on the use of selective cannabinoid receptor antagonists to help patients stop smoking. In addition, preliminary results on use of therapeutic angiogenesis in patients with Buerger's disease has demonstrated excellent collateral blood vessels formation and clinical improvement.

SUMMARY

The difficulty in studying rare diseases such as thromboangiitis obliterans is that there are no significant research dollars available and even the most active centers only see a few patients per year. Therefore, there has been little progress in understanding the pathogenesis of the disease. There are new therapeutic modalities that help patients with this disease, however, and patients can be assured that if they are able to discontinue tobacco use completely, amputation will not occur if critical limb ischemia is not already present.

Endoscopic VATS sympathectomy: the uniportal technique

Presentation of the uniportal VATS sympathectomy technique: through a single port incision, a videothoracoscope, a diathermy hook and, if needed, a lung grasper are introduced into the pleural cavity. Upon identification of the sympathetic chain, the relevant ganglia are divided. By extending laterally the dissection, the aberrant accessory sympathetic nerve fibers are also severed. Anatomic variations are illustrated and an overview of the literature is presented.