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J Thorac Cardiovasc Surg 2007;133:1428-1433
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Long-term effects of thoracic sympathectomy on microcirculation in the hands of patients with primary Raynaud disease

Pawe Maga, MD, PhD^a,_*, Jarosaw Kuda, MD, PhD^b, Rafa Niankowski, MD, PhD^a, Andrzej Szczeklik, MD, PhD^a, Krzysztof Sadek, MD, PhD^a

^a Department of Medicine, Jagiellonian University, Kraków, Poland
^b Department of Thoracic Surgery, Sokoowski Hospital, Zakopane, Poland.

Received for publication October 3, 2006; revisions received December 4, 2006; accepted for publication December 12, 2006.

^_* Address for reprints: Pawe Maga, MD, PhD, Department of Medicine, Jagiellonian University, Kraków, Poland. (Email: p.maga{at}chello.pl).

Objective: Videothoracoscopic sympathecomy is a widely used treatment modality in patients with severe Raynaud disease, but the reported late results are less than favorable. There have been no direct studies of the long-term effect of sympathectomy on microcirculation in the hands of these patients.

Methods: In 25 patients with Raynaud disease treated with videothoracoscopic Th2-Th4 sympathectomy, we performed basal laser-Doppler flowmetry and measured the maximal refilling time after 1-minute occlusion measurements preoperatively and at 1 week, 6 months, and 1, 2, 3, and 5 years after the sympathectomy. The results were compared with the same measurements obtained in the group of 50 healthy individuals.

Results: The patients’ symptom severity was assessed by using the visual analogue scale. The basal capillary flow and the maximal refilling time improved after the sympathectomy to a level not different from that seen in the healthy population, and the effect was maintained during the 5-year follow-up period. The patients’ symptom severity scores diminished to zero in the early postoperative period and increased to 28% of their initial value 5 years after the operation.

Conclusions: The videothoracoscopic Th2-Th4 sympathectomy produces excellent and long-lasting improvement of microcirculation function in patients with Raynaud disease. The mild return of symptoms might be due to factors other than the capillary blood flow alterations.