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SYMPATHECTOMY IN THE OBLITERATING DISEASES OF UPPER LIMB ARTERIES

Mykhaylichenko V. Yu., Orlov A. G., Samarin S. A., Sulima A. N.

Abstract: Aim. To improve the results of surgical treatment of distal ischemia of the upper extremities by developing indications for the application of various surgical treatment methods, as well as analyzing the results of surgical treatment of distal ischemia of the upper extremities. Materials and methods. In the period from 2006 to 2016 the staff of the Department of General Surgery operated 64 patients with chronic ischemia of the distal upper extremities. Men - 44, women - 20. Age ranged from 26 to 92 years, the average age was 49.09 years. The criteria proposed by E. Allen et G. Brown were used. For the diagnosis of obliterating rombangiitis, we were based on the method of excluding other possible nosologies and using Shionoy’s clinical criteria. All patients were subjected to clinical and laboratory and instrumental examination. The patients underwent the following surgical procedures: thoracoscopic sympathectomy in 21 cases (32.8%), thoracic sympathectomy in 12 (18.8%), digital periarterial sympathectomy in 31 (48.4%) cases. In 4 cases, open thoracic sympathectomy was supplemented by scalenotomy. Results. In all patients who underwent intervention on the palmar arterial arch, the main blood flow was restored. The data of triplex scanning of the arterial arch of the hand and the finger arteries and transcutaneous oximetry indicate an increase in the linear velocity of blood flow and a decrease in the indices of peripheral vascular resistance in all cases. The linear blood flow rate in patients with thromboangiitis obliterans after performing digital periarterial sympathectomy increased on average by 64%, in patients with CP, by 100%, in patients with atherosclerosis obliterans, by 135%. Thus, we see that according to the parameters studied, the most effective sympathectomy turned out to be in Raynaud's syndrome and atherosclerosis obliterans. Less effective - with thromboangiitis obliterans. Moreover, it should be noted that digital periarterial sympathectomy has a number of advantages over breast. Conclusions. Periarterial digital sympathectomy gives a pronounced long-lasting effect, which makes it possible to consider it as a method of choice in the treatment of acral ischemia of the hand. Direct intervention on the arterial arch of the hand in some cases allows to restore the main blood flow, which significantly improves the results of treatment. Digital periarterial sympathectomy in Raynaud's syndrome and atherosclerosis obliterans allows to achieve better results of treatment than thoracic sympatectomy. However, due to the fact that periarterial sympathectomy requires a highly qualified specialist and an operating microscope, in the absence of such, thoracic sympathectomy should be performed. Key words: sympathectomy, obliteration of upper limb arteries.

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