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| EXPERT COMMENT |
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| Year : 2017 | Volume
: 4
| Issue : 4 | Page : 191 |
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Comments by Prof Dr. N. Sekar
N Sekar
Department of Vascular Surgery, Apollo Hospitals; Department of Vascular Surgery, Kauvery Hospital, Chennai, Tamil Nadu, India
| Date of Web Publication | 31-Oct-2017 |
Correspondence Address:
N Sekar
Department of Vascular Surgery, Apollo Hospitals; Department of Vascular Surgery, Kauvery Hospital, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijves.ijves_46_17
How to cite this article:
Sekar N. Comments by Prof Dr. N. Sekar. Indian J Vasc Endovasc Surg 2017;4:191 |
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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