Endoscopic Surgery

doi: 10.25005/2074-0581-2017-19-2-245-248
THE FIRST EXPERIENCE OF VIDEO-THORACOSCOPIC UPPER-PECTORAL SYMPATHECTOMY UNDER THE RAYNAUD’S PHENOMENON

R. Rakhmatullaev1, B.U. Abduvahidov2

1Medical and Sanitary Department of the State Unitary Enterprise «Tajik Aluminum Company», Tursunzade, Tajikistan
2Medical Complex «Istiklol» of the Health Department of the Hukumat of Dushanbe City, Dushanbe, Tajikistan

Objective: To study the results of the first experience of endoscopic upper-pectoral sympathectomy (UPS) under the Raynaud’s phenomenon.

Methods: The results of the performance of video thoracoscopic UPS in 16 patients with the idiopathic form of the Raynaud’s phenomenon are analyzed. Women were 12 (75%), men – 4 (25%) at the age of 14 to 24 years (the average age was 24.9±3.7 years). All patients had a second stage of the disease with symptoms of chronic ischemia of hands II-III degrees. The average duration of the onset of the disease till the operative treatment was 3.2±0.4 years.

Results: A characteristic clinical sign of the disease was the symmetrical affection of the hands with the phenomena of cyanosis, hyperemia, mottled skin and hyperhidrosis. According to Doppler Scan, in all cases, a decrease in the linear velocity of the blood flow in the arteries of the forearm, hand and fingers, increasing of index resistibility with reduction of the pulsating index. All 16 patients underwent videothoracoscopic UPS. The duration of the operation was 98.5±10.5 min. Intra- and postoperative complications were not observed. In the nearest postoperative period no complications were observed, the regress of Raynaud’s symptoms was noted, an increase in the blood flow velocity was recorded in the arteries of the hands and fingers in the Ultrasound Diagnostic. A year later, in the cold season, a part of patients (n=3) again have moderate signs of the disease; these patients underwent complex conservative therapy. Remote results are in the studying stage.

Conclusions: The UPS, by any means, is performed, is an effective and reasonable procedure. Timely surgical treatment prevents the progression of the disease and the development of complications and improves the quality of life of patients.

Keywords: Raynaud phenomenon , hand’s ischemia, sympathectomy, video-thoracoscopy.

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References
  1. Sultanov DD, Karimov TN. Revaskulyarizatsiya pri distal’nykh porazheniyakh arteriy verkhnikh konechnostey [Revascularization in distal lesions of upper extremities arteries]. Vestnik Avicenny [Avicenna Bulletin]. 2012;2:167-73.
  2. Sadriev ON, Dzhuraev ShM, Kosimov YuM, Tohirov FS, Giyosiev IK, Rakhimov FR. Sluchay uspeshnogo endovaskulyarnogo lecheniya okklyuzii levoy podklyuchichnoy arterii [The case of successful endovascular treatment of the left subclavian artery occlusion]. Zdravookhranenie Tadzhikistana. 2016;4:85-9.
  3. Alukhanyan OA, Martirosyan KhG, Aristov DS, Kurgansky OV. Verkhnegrudnaya simpatectomiya v lechenii ishemii verkhnikh konechnostey pri porazheniyakh distal’nogo arterial’nogo rusla [Upper thoracic sympathectomy in treatment of upper limb ischaemia in distal lesions of the arterial bed]. Angiologiya i sosudistaya khirurgia [Angiology and vascular surgery]. 2013;19(3):123-8.
  4. Hughes M, Herrick AL. Raynauds phenomenon. Best Pract Res Clin Rheumatol. 2016;30(1):112-32. Available from: http://dx.doi. org/10.1016/j.berh.2016.04.001
  5. Brown S. Diagnosis and management of patients with Raynaud’s phenomen. Nurs Stand. 2012;26(46):41-6.
  6. Herrick AL. The pathogenesis, diagnosis and treatment of Raynaud phenomenon. Net Rev Rheumatol. 2012;8(8):469-79. Available from: http://dx.doi.org/10.1038/nrrheum.2012.96.
  7. Tabeeva GR, Glazychev OS, Fokina NM, Dudnik EN. Optimizatsiya terapii bolezni Reyno [Optimization of treatment of Raynaud’s disease]. Сonsilium medicum. 2007;9(8):57-60.
  8. Seibold JR, Wigley FM. Clinical Trials in Raynaud Phenomen: A spoonful of sugar (pill) makes the medicine go down (in flames). Arthritis Rheumatol. 2017; Available from: http://dx.doi.org/10.1002/art.40307.
  9. Nitsche A. Raynaud, digital ulcers and calcinosis in scleroderma. Reumatol Clin. 2012;8(5):270-7.
  10. Stewart M, Morling JR. Oral vasodilators for primary Raynauds phenomen. Cochrane Database Syst. Rev. 2012;Jul 11:7:CD006687. Available from: http://dx.doi.org/10.1002/14651858.CD006687.pub3.
  11. Konunova DM, Sadriev ON. Sravnitel’naya otsenka otkrytoy i torakoskopicheskoy selektivnoy sheyno-grudnoy simpatektomii pri bolezni Reyno [Comparative evaluation of open and thoracoscopic selective cervical and thoracic sympathectomy in patients with Reynaud’s syndrome]. Nauka molodykh (Eruditio Juvenium). 2014;2:60-8.
  12. Kwong KF, Cooper LB, Bennett LA, Burrows W, Gamliel Z, Krasna MJ. Clinical experience in 397 consecutive thoracoscopic sympathectomies. Ann Thorac Surg. 2005;80(3):1063-6.
  13. Coveliers H, Hoexum F, Rauwerda JA, Wisselink W. Endoscopic thoracic sympathectomy for upper limb ischemia. A 16 year follow-up in a single center. Surgeon. 2016;14(5):265-9. Available from: http://dx.doi. org/10.1016/j.surge.2015.03.002.
  14. Sultanov DD, Tukhtaev FM, Kurbanov NR, Sadriev ON. Sindrom verkhney grudnoy apertury [Syndrome of upper thoracic aperture]. Vestnik Avicenny [Avicenna Bulletin]. 2014;3:121-7.

Authors informations:

Rakhmatullaev Rakhimdzhon, Doctor of Medical Sciences, Head Physician of the Medical and Sanitary Department of the State Unitary Enterprise «TALCO»

Abduvakhidov Bahodur Ulmasovich, Doctor of Medical Sciences, Head of the Department of Pediatric Cardiac Surgery of Medical Complex «Istiklol» of the Health Department of the Hukumat of Dushanbe City

Address for correspondence:

Rakhmatullaev Rakhimdzhon

Doctor of Medical Sciences, Head Physician of the Medical and Sanitary Department of the State Unitary Enterprise «TALCO»

735014, Republic of Tajikistan, Tursunzade, str. Frantsuzogorodok, MSD SUE «TALCO»

Tel.: (+992) 935 057643

E-mail: rncssh@mail.ru

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