Sympathectomy; radial artery
CPT4 code
Name of the Procedure:
Sympathectomy; Radial Artery Common Name(s):
- Radial Artery Sympathectomy
- Upper Limb Sympathectomy
Technical/Medical Terms:
- Radial arterial denervation
- Upper extremity sympathectomy
Summary
A radial artery sympathectomy is a surgical procedure where certain nerves that support the radial artery in the arm are selectively cut or destroyed. This helps alleviate symptoms associated with overactivity of these nerves, such as excessive sweating or pain.
Purpose
The primary aim of a radial artery sympathectomy is to treat conditions like Raynaud's disease or complex regional pain syndrome (CRPS) that affect the upper limbs. By interrupting the sympathetic nerve pathways, the procedure helps reduce pain, improve blood flow, and decrease excessive sweating and other related symptoms.
Indications
Specific symptoms or conditions:
- Severe Raynaud's disease
- Complex Regional Pain Syndrome (CRPS)
- Hyperhidrosis (excessive sweating) of the upper limb
Patient criteria:
- Individuals who have not responded to conservative treatments
- Patients experiencing severe discomfort or reduced quality of life due to symptoms
Preparation
Pre-procedure instructions:
- Fasting for at least 8 hours before the procedure
- Discussing current medications with the healthcare provider; some medications may need to be stopped
- Undergoing a physical examination and possibly blood tests
Diagnostic tests:
- Doppler ultrasound to assess blood flow
- Nerve conduction studies
Procedure Description
Step-by-step explanation:
- The patient is placed under general or local anesthesia.
- A small incision is made near the wrist to access the radial artery.
- The surgeon identifies and selectively cuts or destroys the targeted sympathetic nerves using a scalpel or other surgical instruments.
- Hemostasis is ensured, and the incision is closed with sutures or surgical glue.
- The area is bandaged and monitored.
Tools and technology:
- Surgical scalpel
- Electrocautery devices
- Hemostatic agents
Anesthesia:
- General anesthesia or local anesthesia with sedation
Duration
The procedure typically takes about 1 to 2 hours.
Setting
This surgery is usually performed in a hospital's operating room or an outpatient surgical center.
Personnel
- Surgeon (typically a vascular or neurosurgeon)
- Anesthesiologist
- Surgical nurse
- Operating room technician
Risks and Complications
Common risks:
- Infection
- Bleeding
- Temporary or permanent numbness around the incision site
Rare risks:
- Arterial damage
- Incomplete relief of symptoms
- Compensatory sweating in other areas
Benefits
Expected benefits:
- Relief from chronic pain
- Improved blood circulation in the upper limbs
- Reduction in excessive sweating
Timeframe for benefits:
- Some improvement may be noticed immediately, with full benefits typically observed within a few weeks.
Recovery
Post-procedure care:
- Keeping the incision site clean and dry
- Taking prescribed pain medications
- Gradually resuming normal activities as recommended by the doctor
Expected recovery time:
- Usually, patients can return to regular activities within 1-2 weeks, but full recovery might take several weeks.
Restrictions and follow-up:
- Avoid heavy lifting and strenuous activities for at least a few weeks
- Follow-up appointments to monitor healing and symptom relief
Alternatives
Other treatment options:
- Medications (e.g., calcium channel blockers, pain relievers)
- Physical therapy
- Nerve blocks or injections
Pros and cons of alternatives:
- Medications and therapies are less invasive but may not provide long-term relief.
- Nerve blocks offer temporary relief and might need to be repeated.
Patient Experience
During the procedure:
- The patient will be under anesthesia and should not feel pain.
After the procedure:
- Some soreness and discomfort at the incision site are expected.
- Pain management includes prescribed medications and comfort measures like ice packs.
- Gradual improvement in symptoms should be noticeable within days to weeks.