Literature Reviews
doi: 10.25005/2074-0581-2018-20-1-113-119
TO THE QUESTION OF THE UPPER LIMB DESYMPATHISATION IN RAYNAUD’S PHENOMENON

R. Rakhmatullaev1, B.U. Abduvakhidov2, O.N. Pulatov3, F.Sh. Rashidov4, I.I. Boltabaev4

1Medical and Sanitary Department of the State Unitary Enterprise "Tajik Aluminum Company", Tursunzade, Republic of Tajikistan
2Istiklol Medical Complex, Dushanbe, Republic of Tajikistan
3Sogd Regional Center of Cardiology and Cardiovascular Surgery, Khujand, Republic of Tajikistan
4Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan

Objective: The review discussed the most important aspects of the implementation of various variants of upper sympathectomy under the Raynaud’s phenomenon. A short characteristic given, the indications, effectiveness and frequency of complications of open, video-thoracoscopic and periarterial digital sympathectomy, as well as the methods of chemical sympatholysis disclosed. The reasons for the relapse of the Raynaud’s phenomenon, in particular, include the preservation of additional sympathetic innervation of the upper limb, progressive immune aggression, rapid regeneration of the intersected nerve trunks, and the variability of the anatomy of the sympathetic nervous system discussed in details. In addition, the work reflects the issues of the volume of cervical and thoracic sympathectomy and their comparative effectiveness in the early and late periods of observation. The literature data show that the effectiveness of sympathectomy in the long-term follow-up period remains at 43.3-93.3% and depends, first, on the method of its conduct, the stage and genesis of the disease, and on the effect of trigger factors of vasospasm. Despite the contradictory results of the upper extremity sympathectomy in the Raynaud’s phenomenon, it continues to be the only hope in the arsenal of vascular surgeons, which in most cases can improve the circulation of the fingers and the hand.

Keywords: Raynaud’s phenomenon, thoracic sympathectomy, chemical sympatholysis, videotoracoscopy, results.

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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 Avitsenny [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. 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.
  4. Huisstede BM, Hoogvliet P, Paulis WD, van Middelkoop M, Hausman M, Coert JH, Koes BW. Effectiveness of interventions for second-ary Raynaud's phenomenon: a systematic review. Arch Phys Med Rehabil. 2011; 92(7):1166-80. Available from: http://dx.doi/10.1016/j.apmr.2011.01.022.
  5. Devulder J, van Suijlekom H, van Dongen R, Diwan S, Mekhail N, van Kleef M, Huygen F. Ischemic pain in the extremities and Raynaud's phenomenon. Pain Pract. 2011;11(5):483-9. Available from: http://dx.doi/10.1111/j.1533-2500.2011.00460.x.
  6. Khan MI, Tariq M, Rehman A, Zafar A, Sheen SN. Efficacy of cervicotho-racic sympathectomy versus conservative management in patients suffer-ing from incapacitating Raynaud's syndrome after frost bite. J Avub Med Coll Abbottabad. 2008;20(2):21-4.
  7. Kalmykov EL, Suchkov IA, Nematzoda ON. K voprosu o poyasnichnoy simpatektomii [On the problem of lumbar sympathectomy]. Angiologiya i sosudistaya khirurgiya. 2017;23(4):181-5.
  8. Konunova DM, Sadriev ON. Sravnitel’naya otsenka otkrytoy torakos-kopicheskoy selektivnoy sheyno-grudnoy simpatektomii pri bolezni Reyno [Comparative evaluation of open and thoracoscopic selective cervi-cal and thoracic sympathectomy in patients with Reynaud’s syndrome]. Nauka molodykh (Eruditio Juvenium). 2014;2:60-8.
  9. Sultanov DD, Tukhtaev FM, Kurbanov NR, Sadriev ON. Sindrom verkh-ney grudnoy apertury [Syndrome of upper thoracic aperture]. Vestnik Avitsenny [Avicenna Bulletin]. 2014;3:121-7.
  10. Minimoshvili OI, Shapovalov IN, Nikonova OA, Perepelitsa SV. Nash opyt videotorakoskopicheskikh operatsiy na organakh grudnoy kletki [Our experience of thoracoscopic operations on chest]. Vestnik neotlozhnoy i vosstanovitel'noy meditsiny. 2010;11(3):305-8.
  11. Gaibov AD, Kakhorov AZ, Sadriev ON, Yunusov KA. Khirurgicheskoe lechenie sindroma verhney grudnoy apertury [Surgical treatment of supe-rior thoracic outlet syndrome]. Vestnik khirurgii. 2015;174(1):78-83. Available from: http://dx.doi.org/10.24884/0042-4625-2015-174-1-78-83.
  12. Bakst R, Merola JF, Franks AG Jr, Sanchez M. Raynaud's phenomenon: pathogenesis and management. J Am Acad Dermatol. 2008; 59(4):633-53. Available from: http://dx.doi.org/10.1016/j.jaad.2008.06.004.
  13. Konunova DM, Sultanov DD, Gaibov AD, Sadriev ON, Kamolov AN. Kompleksnaya diagnostika i sovremennye printsipy lecheniya bolezni Reyno [Comprehensive diagnosis and modern treatment principles Ray-naud’s disease]. Vestnik pedagogicheskogo universiteta. 2015;2-2:111-5.
  14. Shnitko SN, Strinkevich AL. Khirurgicheskiy i videoendokhirurgicheskiy metody desimpatizatsii pri lechenii bolezni Reyno u voennosluzhashchikh [Surgical and videoendosurgical methods of desympatization in the treat-ment of Raynaud's disease in the military]. Voennaya meditsina. 2007;4:73-5.
  15. Kao M. Endoscopic procedures of the upper thoracic sympathetic chain. Arch. Surg. 1995;130(10):1243.
  16. Rakhmatullaev R, Abduvakhidov BU. Pervyy opyt videotorakoskopich-eskoy verkhnegrudnoy simpatektomii pri fenomene Reyno [The first ex-perience of videothoracoscopic upper-pectoral sympathectomy under the Raynaud ’s phenomenon]. Vestnik Avitsenny [Avicenna Bulletin]. 2017;19(2):245-8. Available from: http://dx.doi.org/10.25005/2074-0581-2017-19-2-245-248.
  17. Hoexum F, Coveliers HM, Lu JJ, Jongkind V, Yeung KK, Wisselink W. Thoracic sympathectomy for upper extremity ischemia. Minerva Cardio-angiol. 2016;64(6): 676-85.
  18. Eroshkin AA, Miminoshvili OI, Mykhaylichenko VYu. Torakoskopich-eskaya simpatektomija pri lechenii obliteriruyushchikh zabolevaniy arteriy verkhnikh konechnostey [Thoracoscopic sympathectomy in treatment of upper extremities obliterating arteries diseases]. Aktual'nye problemy transportnoy meditsiny. 2014;1(2):146-51.
  19. Paleru C, Dănăilă O, Bordîncă I, Istrate A, Bolca C, Cordoş I. Thoraco-scopic sympathectomy for arterial ischemia of the upper extremities: a case report. Pneumologia. 2007;56(4):208-10.
  20. Karimov ShI, Berkinov UB, Krotov NF, Ganiev DA. Opyt torakos-kopicheskoy simpatektomii pri distal'nykh porazheniyakh arteriy konech-nostey [Experience with thoracoscopic sympathectomy in distal lesions of lower-limb arteries]. Vestnik Rossiyskoy akademii meditsinskikh nauk. 2011;1:18-22.
  21. Coveliers HM, Hoexum F, Nederhoed JH, Wisselink W, Rauwerda JA. Thoracic sympathectomy for digital ischemia: a summary of evidence. J Vasc Surg. 2011;54(1):273-7. Available from: http://dx.doi:10.1016/j.jvs.2011.01.069.
  22. Minimoshvili OI, Perepelitsa SV, Shapovalov IN. Sravnitel'naya otsenka rezul'tatov otkrytoy i endoskopicheskoy grudnoy simpatektomii v lechenii fenomena Reyno [Comparative estimation of the results of open and en-doscopic thoracic sympathectomy in the treatment of Raynaud's phenom-enon]. Klіnіchna khіrurgіya. 2010;10:16-9.
  23. Mikhaylichenko VYu, Orlov AG, Ivanenko AA. Metody khirurgicheskoy korrektsii khronicheskoy akral'noy ishemii verkhnikh konechnostey [Methods of surgical correction chronic distal ischemia of the upper ex-tremities]. Sovremennye problemy nauki i obrazovaniya. 2016;4:116-20.
  24. Aslanov AD, Zhirikov AV, Kugotov AG. Lechenie fenomena Reyno na Severnom Kavkaze [Tratment of Raynauds phenomenon in the North Caucasus]. Sovremennye problemy nauki i obrazovaniya. 2015;3:226-32.
  25. Li PY, Gu HH, Liang WM. Sequential one-lung ventilation using one Arndt endobronchial blocker in a pediatric patient undergoing bilateral, video-assisted thoracoscopic surgery (VATS). J Clin Anesth. 2009;21(6):464. Available from: http://dx.doi/10.1016/j.jclinane.2009.02.005.
  26. Konunova DM, Sultanov DD, Avgonov UM, Gulmuradov TG. Videoto-rakoskopicheskaya sheyno-grudnaya simpatektomiya v lechenii bolezni Reyno [Videothoracoscopic cervico-thoracic sympathectomy in treatment of Raynaud's disease]. Doklady Akademii nauk Respubliki Tadzhikistan. 2014;57(6):520-5.
  27. Brock M, Frangakis C, Georgiades CS. CT-Guided, percutaneous ethanol sympatholysis for primary hyperhidrosis. Cardiovasc Intervent Radiol. 2018;41(3):477-82. Available from: http://dx.doi/10.1007/s00270-017-1806-y.
  28. Soberón JRJr, Greengrass RA, Davis WE, Murray PM, Feinglass N. So-berón Intermediate-term follow-up of chronically ill patients with digital ischemia treated with peripheral digital sympathectomy. Rheumatol Int. 2016;36(2):301-7. Available from: http://dx.doi/10.1007/s00296-015-3383-1.
  29. Han JT, Zhao J, Peng YG. Experience in treatment of Raynaud's syndrome by chemical sympathectomy: 97 cases. Beijing Da Xue Xue Bao Yi Xue Ban. 2008;40(3):310-3.
  30. Huisstede BM, Hoogvliet P, Paulis WD, van Middelkoop M, Hausman M, Coert JH, et al. Effectiveness of interventions for secondary Raynaud’s phenomenon: a systematic review. Arch Phys Med Rehabil. 2011;92:1166-80. Available from: http://dx.doi.org/10.1016/j.apmr.2011.01.022.
  31. Mykhaylichenko VYu, Orlov AG. Effektivnost' primeneniya periarteri-al'noy simpatektomii u bol'nykh s akral'noy ishemiey verhnikh konech-nostey [Effectiveness of periarterial sympathectomy in patients with acral ischemia paper limb]. Mezhdunarodnyy zhurnal prikladnykh i fundamen-tal'nykh issledovaniy. 2016;11(5):906-8.
  32. Pace CS, Merritt WH. Extended periarterial sympathectomy: evaluation of long-term outcomes. Hand (NY). 2017;1:1558944717715119. Available from: http://dx.doi/10.1177/1558944717715119.
  33. Merritt WM. Role and rationale for extended periarterial sympathectomy in the management of severe Raynaud syndrome: techniques and results. Hand Clin. 2015;31:101-20.
  34. Wang WH, Lai CS, Chang KP, Lee SS, Yang CC, Lin SD, Liu CM. Pe-ripheral sympathectomy for Raynaud's phenomenon: a salvage procedure. Kaohsiung J Med Sci. 2006;22(10):491-9. Available from: http://dx.doi.org/10.1016/S1607-551X(09)70343-2.
  35. Jeon SB, Ahn HC, Ahn YS, Choi MS. Two-step incision for periarteri-al sympathectomy of the hand. Arch Plast Surg. 2015;42(6):761-8. Avail-able from: http://dx.doi/10.5999/aps.2015.42.6.761.
  36. Letamendia A, López-Román J, Bustamante-Munguira J, Herreros J. Digi-tal periarterial sympathectomy in the management of post-traumatic Ray-naud syndrome. J Vasc Surg. 2016;63:459-65. Available from: http://dx.doi.org/10.1016/j.jvs.2015.08.102.
  37. García-Carrasco M, Jiménez-Hernández M, Escárcega RO, Mendoza-Pinto C, Pardo-Santos R, Levy R, et al. Treatment of Raynaud's phenomenon. Autoimmun Rev. 2008;8(1):62-8. Available from: http://dx.doi/10.1016/j.autrev.2008.07.002.
  38. Lee R, Lomas O, Handa A. Severe Raynaud's phenomenon-A streamlined approach to acute management. Int J Surg Case Rep. 2011;2(4):61-3. Available from: http://dx.doi.org/doi:10.1016/j.ijscr.2011.02.001.
  39. Seibold JR, Wigley FM. Clinical trials in Raynaud's phenomenon: a spoonful of sugar (pill) makes the medicine go down (in flames). Arthritis Rheumatol. 2017;69(12):2256-8.Available from: http://dx.doi.org/10.1002/art.40307.
  40. Alukhanyan OA, Martirosyan KhG, Aristov DS, Kurgansky OV. Verkh-negrudnaya simpatektomiya v lechenii ishemii verkhnikh konechnostey pri porazheniyakh distal'nogo arterial'nogo rusla [Upper thoracic sympa-thectomy in treatment of upper limb ischaemia in distal lesions of the arte-rial bed]. Angiologiya i sosudistaya khirurgiya. 2013;19(3):123-8.
  41. Hashmonai M, Cameron AE, Licht PB, Hensman C, Schick CH. Thorac-ic sympathectomy: a review of current indications. Surg Endosc. 2016;30(4):1255-69. Available from: http://dx.doi/10.1007/s00464-015-4353-0.
  42. Zhang W, Wei Y, Jiang H, Xu J, Yu D. T3 versus T4 thoracoscop-ic sympathectomy for palmar hyperhidrosis: a meta-analysis and system-atic review. J Surg Res. 2017;218:124-31. Available from: http://dx.doi.org/10.1016/j.jss.2017.05.063.
  43. Lee SS, Lee YU, Lee JH, Lee JC. Comparison of the long-term results of R3 and R4 sympathicotomy for palmar hyperhidrosis. Korean J Thorac Cardiovasc Surg. 2017;50(3):197-201. Available from: http://dx.doi.org/10.5090/kjtcs.2017.50.3.197.
  44. Gossot D. Sympathectomie selective endoscopique pour hyperhidrose palmare. La presse medicale. 1995;24(37):1739-42.
  45. Eroshkin AA, Mikhaylichenko VYu. Analiz optimal'nogo urovnya simpa-totomii pri vypolnenii torakoskopicheskoy operatsii po povodu pervich-nogo gipergidroza [Optimal sympathotomy level analysis in thoracoscopic operation of primary hyperhidrosis]. Tavricheskiy mediko-biologicheskiy vestnik. 2014;17(2):42-5.
  46. Orlov AG. Aktual'nye voprosy lecheniya khronicheskoy akral'noy ishemii verkhnikh konechnostey [Current issues the treatment of acral ischemia of the upper limbs]. Tavricheskiy mediko-biologicheskiy vestnik. 2017;20(1):45-9.
  47. Alekperov RT, Starovoytova MN. Sindrom Reyno v praktike terapevta [Raynaud’s phenomenon in the therapist practice]. RMZH. 2010;18:1695-700.
  48. Provorova NYu. Patogeneticheskie aspekty sindroma Reyno [Pathogenet-ic aspects of Raynaud's phenomenon]. Byulleten' Severnogo gosudarstven-nogo meditsinskogo universiteta. 2016;1:226-8.
  49. Putilina MV. Fenomen Reyno v praktike vracha-internista [Raynaud's phenomenon in the practice of internist]. Farmateka. 2015;20:24-31.
  50. Alekperov RT. Sindrom Reyno v praktike revmatologa [Raynaud’s phe-nomenon in the rheumatologist’s practice]. Sovremennaya revmatologiya. 2014;2:48-57. Available from: http://dx.doi.org/10.14412/1996-7012-2014-2-48-57.
  51. Ponomarenko GN, Kutin YuS. Fizioterapiya patsientov s bolezn'yu Reyno [Physiotherapy of patients with Raynaud''s desease]. Fizioterapevt. 2010;1:49-50.
  52. Alekperov RT. Sindrom Reyno kak mul'tidisstiplinarnaya problema [Raynaud’s phenomenon: a multidisciplinary problem]. Al'manakh klinicheskoy meditsiny. 2014;35:94-100.
  53. Herrick AL. The pathogenesis, diagnosis and treatment of Raynaud phe-nomenon. Net Rev Rheumatol. 2012;8(8):469-79. Available from: http://dx.doi.org/10.1038/nrrheum.2012.96
  54. Stewart M, Morling JR. Oral vasodilators for primary Raynauds phe-nomen. Cochrane Database Syst. Rev. 2012;Jul 11:7:CD006687. Available from: http://dx.doi.org/10.1002/14651858.CD006687.pub3.

Authors' information:

Rakhmatullaev Rakhimdzhon,
Doctor of Medical Sciences, Head Physician of the Medical and Sanitary Department of the State Unitary Enterprise "Tajik Aluminum Company"

Abduvakhidov Bahodur Ulmasovich,
Doctor of Medical Sciences, Head of the Department of Pediatric Cardiac Surgery, Istiklol Medical Complex

Pulatov Orifdzhon Negmatovich,
Candidate of Medical Sciences, Head of the Department of Vascular Surgery, Sogd Regional Center of Cardiology and Cardiovascular Surgery

Rashidov Fakhriddin Shamsiddinovich,
Candidate of Medical Sciences, Senior Researcher, Republican Scientific Center for Cardiovascular Surgery

Boltabaev Ikrom Ismailovich,
Candidate of Medical Sciences, Head of the Department of Congenital Heart Disease, Republican Scientific Center for Cardiovascular Surgery

Conflicts of interest: No conflict

Address for correspondence:

Rakhmatullaev Rakhimdzhon

Doctor of Medical Sciences, Head Physician of the Medical and Sanitary Department of the State Unitary Enterprise "Tajik Aluminum Company"

735014, Republic of Tajikistan, Tursunzade, str. Frantsuzogorodok

Tel.: (+992) 935 057643

E-mail: rncssh@mail.ru

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