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EXPERT COMMENT
Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 191

Comments by Prof Dr. N. Sekar


Department of Vascular Surgery, Apollo Hospitals; Department of Vascular Surgery, Kauvery Hospital, Chennai, Tamil Nadu, India

Date of Web Publication31-Oct-2017

Correspondence Address:
N Sekar
Department of Vascular Surgery, Apollo Hospitals; Department of Vascular Surgery, Kauvery Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_46_17

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How to cite this article:
Sekar N. Comments by Prof Dr. N. Sekar. Indian J Vasc Endovasc Surg 2017;4:191

How to cite this URL:
Sekar N. Comments by Prof Dr. N. Sekar. Indian J Vasc Endovasc Surg [serial online] 2017 [cited 2020 Feb 23];4:191. Available from: http://www.indjvascsurg.org/text.asp?2017/4/4/191/217455



It is well established that patients with Buerger's disease respond well to good and aggressive medical treatment. This includes abstinence from tobacco, good wound care, anticoagulants, and vasodilators. Hence, improvement seen in many of the patients cannot be credited to sympathectomy alone. Moreover, the effect of sympathectomy is short lived and vasomotor tone returns quickly. Hence, sympathectomy should never be offered as the first line of treatment as suggested by the authors.

As many as 44.6% (46/103) patients had proximal arterial block and they could suffer from diseases other than Buerger's disease. Many of them may have patent distal vessels suitable for bypass surgery. Hence, angiography is essential in all these patients before deciding on course of treatment.

We recommend sympathectomy only for patients with rest pain or minor tissue loss (Class IV or V) who have nonreconstructible lesions or failed reconstruction or as an adjunct to reconstruction when the outflow is poor.

There is no doubt that chemical sympathectomy is safer and better than open sympathectomy, but its indications have been reduced.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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