Subject(s)
Arterial Occlusive Diseases , Bicycling/injuries , Iliac Artery , Ankle Brachial Index/methods , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/surgery , Delayed Diagnosis , Diagnosis, Differential , Diagnostic Errors , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/pathology , Iliac Artery/surgery , Male , Middle Aged , Pain/diagnosis , Radiography , Time Factors , Treatment OutcomeABSTRACT
Endoscopic thoracic sympathectomy (ETS) has gained increasing popularity due to its minimally invasive character. Despite the simplicity of the procedure, non-surgical options should always be considered as the first line of treatment. The complication risk of ETS is low but side effects, primarily compensatory sweating (CS) of mainly the trunk, may be severe enough to cause regret of the procedure. The risk/benefit ratio should always be discussed with the patient. Severe palmar hyperhidrosis and facial blushing respond very well to ETS with a high patient satisfaction rate. Facial hyperhidrosis is effectively treated with ETS, but is associated with a high risk for severe CS. Axillary hyperhidrosis is best treated by means other than ETS. The use of ETS for pain syndromes, vascular insufficiency and angina pectoris is not well supported by scientific evidence, making careful patient selection mandatory.
Subject(s)
Angina Pectoris/surgery , Blushing , Hyperhidrosis/surgery , Pain/surgery , Sympathectomy , Thoracoscopy , Vascular Diseases/surgery , Arm , Face , Hand/blood supply , Humans , SyndromeABSTRACT
BACKGROUND: Severe facial blushing may have a strong negative impact on the quality of life and is one of the cardinal symptoms of social phobia. If traditional therapeutic options such as psychotherapy and pharmacological treatment fail, interruption of the sympathetic innervation to the face offers good results, however long-term results may not be good. AIM: To investigate whether endoscopic thoracic sympathecotomy (ETS) remains an effective treatment of facial blushing more than one year's follow up. METHOD: 1314 consecutive patients with severe facial blushing were treated with bilateral ETS. The results were evaluated by questionnaire and symptoms assessed with visual analogue scales (0-10). RESULTS: The questionnaire was completed by 831 patients (63%) a mean of 29 months (+/- 11 days) after surgery. Facial blushing was reduced from 8.8 +/- 0.05 to 2.5 +/- 0.09, P < 0.0001 by the operation. The quality of life was substantially improved. The main side-effect was redistribution of sweating from the upper to the lower part of the body (compensatory sweating). Increased sweating of the trunk occurred in 83% of the responses. Overall, 85% of the respondents were satisfied with the result and 15% were to some degree not satisfied. CONCLUSIONS: As this is an open study and 37% of patients did not respond to the questionnaire, the results must be viewed with caution. ETS, however, appears to be an effective, safe and lasting surgical method for the treatment of severe facial blushing. Side-effects, especially compensatory sweating on the trunk and legs are common, and may be severe but only rarely result in the patient regretting the operation.
