Surgical Treatment of Systemic Sclerosis - Re-Thinking the Role and Timing of Peripheral Sympathectomy
Arash Momeni, MD, Sarah C. Sorice, MD, Antonia Valenzuela, MD, MS, David F. Fiorentino, MD, PhD, Lorinda Chung, MD, MS, James Chang, MD.
Stanford University Medical Center, Palo Alto, CA, USA.
Systemic sclerosis (SSc) is a rare connective tissue disease associated with significant digital vasculopathy. Peripheral sympathectomy is frequently offered late in the disease process after digital ischemia has already occurred. The purpose of the present study was to critically analyze the results of peripheral sympathectomy in patients with a confirmed diagnosis of SSc.
A retrospective analysis of all SSc patients who underwent peripheral sympathectomy between January 2003 and December 2012 at Stanford University Medical Center was performed. Data regarding patient demographics, clinical features, and postoperative outcomes were retrieved.
Peripheral sympathectomy was performed in 26 hands of 17 patients (88.2% female, 70.6% limited cutaneous SSc, mean age 49.8 years, mean disease duration since first Raynaud symptom 10.5 years). Pain improvement/resolution was seen in 24 hands (92.3%). Digital ulcers healed in all patients with only 2 patients (2 hands; 7.7%) requiring surgical intervention for ulcer recurrence 6 months and 4.5 years later. Minor complications were seen in 7 hands (26.9%); including infection, wound dehiscence, and stitch abscess, but none required surgical intervention.
Peripheral sympathectomy is a well-tolerated procedure in SSc patients and is associated with favorable outcomes with predictable pain relief and ulcer healing in the majority of patients. Prospective studies should be performed to evaluate the safety and efficacy of peripheral sympathectomy at an earlier stage in the disease process.
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