Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis.

PURPOSE: To evaluate, via a systematic review, the effectiveness of radiofrequency (RF) for treatment of primary hyperhidrosis (PH). METHODS: Experimental or observational studies were included where RF treatment (ablation or microneedling) was performed, comparing the periods before and after treatment. RESULTS: Nine studies were considered eligible and included for analysis. In seven of nine studies, patients were subjected to RF only, and in two of nine studies RF was compared to video-assisted thoracoscopic sympathectomy (VATS). There was a reduction in the severity of PH in microneedling (three studies, mean difference -1.24, 95% CI -1.44 to -1.03). In a study that performed sympathetic RF ablation there was a greater reduction in PH severity compared to studies that performed microneedling (-2.42, 95% CI -2.55 to -2.29). There was improvement in the quality of life (QoL) after sympathetic RF ablation (two studies, mean difference -15.92, 95% CI -17.61 to -14.24). Regarding the microneedling procedure, there was a lower improvement in QoL, (two studies, -9.0, 95% CI -9.15 to -8.85). One study comparing sympathetic RF ablation with VATS applied the QoL questionnaire, and the VATS showed superior results. One of the two studies comparing compensatory sweating in RF ablation with VATS showed that compensatory hyperhidrosis was higher in VATS; however, the other study did not observe this difference. One study compared the recurrence of symptoms between VATS and RF ablation; symptom recurrence was shown to be higher in RF. CONCLUSIONS: RF is effective for PH treatment, with superior results obtained with sympathetic ablation compared to microneedling.

Desnervação simpática renal no tratamento da hipertensão arterial resistente : perspectivas atuais / Renal sympathetic denervation for resistant hypertension treatment : current perspectives

Os autores revisam o conceito de hipertensão arterial resistente e o envolvimento do sistema nervoso simpático na hipertensão arterial como base racional para a técnica de desnervação simpática renal (DSR), realizada por via percutânea. A presente revisão é resultado de uma busca ativa de artigos científicos com o nome "renal denervation" na base de dados Medline e PubMed. A técnica e os dispositivos empregados no procedimento são apresentados, bem como os resultados clínicos em seis, 12 e 24 meses após a intervenção com o cateter Symplicity. Observam-se reduções expressivas e progressivamente maiores da PAS e PAD após a DSR. A taxa de complicações foi mínima. Novos dispositivos para a DSR e respectivos estudos clínicos em andamento são citados. Em conclusão, a DSR apresenta-se como um procedimento efetivo e seguro para a abordagem da hipertensão arterial resistente. Resultados de estudos em andamento e tempo maior de seguimento desses pacientes são aguardados para confirmar os resultados iniciais e colocar em perspectiva a ampliação da utilização do procedimento na abordagem da hipertensão arterial.

The authors review the concept of resistant hypertension and the involvement of the sympathetic nervous system in hypertension as a rational basis for the technique of renal sympathetic denervation (RSD) performed percutaneously. This revision is the result of an active search for scientific articles with the term "renal denervation" in the Medline and PubMed databases. The techniques and devices used in the procedure are presented, as well as clinical outcomes at six, 12 and 24 months after the intervention with the Symplicity catheter. Significant decreases and progressively higher reductions of systolic and diastolic blood pressure were observed after RSD. The complication rate was minimal. New devices for RSD and its ongoing clinical studies are cited. In conclusion, the RSD presents itself as an effective and safe approach to resistant hypertension. Results from ongoing studies and longer follow-up of these patients are expected to confirm the initial results and put into perspective the expansion of the procedure use in hypertension approach.

Renal sympathetic denervation for resistant hypertension treatment : current perspectives.

The authors review the concept of resistant hypertension and the involvement of the sympathetic nervous system in hypertension as a rational basis for the technique of renal sympathetic denervation (RSD) performed percutaneously. This revision is the result of an active search for scientific articles with the term "renal denervation" in the Medline and PubMed databases. The techniques and devices used in the procedure are presented, as well as clinical outcomes at six, 12 and 24 months after the intervention with the Symplicity catheter. Significant decreases and progressively higher reductions of systolic and diastolic blood pressure were observed after RSD. The complication rate was minimal. New devices for RSD and its ongoing clinical studies are cited. In conclusion, the RSD presents itself as an effective and safe approach to resistant hypertension. Results from ongoing studies and longer follow-up of these patients are expected to confirm the initial results and put into perspective the expansion of the procedure use in hypertension approach.