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:

1. The patient is placed under general or local anesthesia.
2. A small incision is made near the wrist to access the radial artery.
3. The surgeon identifies and selectively cuts or destroys the targeted sympathetic nerves using a scalpel or other surgical instruments.
4. Hemostasis is ensured, and the incision is closed with sutures or surgical glue.
5. 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.