A Case of Buerger's Disease Effectively Treated by Sympathetic Block Using Clipping

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  • クリッピング術を併用した胸腔鏡下胸部交感神経遮断術 (Endoscopic Thoracic Sympathectomy ; ETS) により改善した左上肢 Buerger 病の 1 例
  • 症例 クリッピング術を併用した胸腔鏡下胸部交感神経遮断術(Endoscopic Thoracic Sympathectomy : ETS)により改善した左上肢Buerger病の1例
  • ショウレイ クリッピングジュツ オ ヘイヨウ シタ キョウコウキョウ カ キョウブコウカン シンケイ シャダンジュツ(Endoscopic Thoracic Sympathectomy : ETS)ニ ヨリ カイゼン シタ ヒダリ ジョウシ Buergerビョウ ノ 1レイ

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Abstract

We report a case of Buerger's disease that was effectively treated by a sympathetic block using clipping. A 67-year-old Japanese man, who was a heavy smoker, experienced episodes of Raynaud's phenomenon in the first and second fingers of his left hand, induced by cold and warm stimuli. Examinations performed at a local hospital, such as blood test and contrast-enhanced computed tomography (CT), revealed no abnormal findings. Thereafter, he visited our department. Digital subtraction angiography revealed arterial stenosis in the left radial artery, which led to a definitive diagnosis of Buerger's disease. As specialists indicated neither percutaneous transluminal angioplasty nor distal bypass, we confirmed the safety of CT-guided thoracic sympathetic ganglion block administered by a pain clinician. We noted skin temperature elevation on thermography but no side effects such as Horner's sign. As no side effect of the sympathetic block was observed, we prescribed respiratory surgery with an endoscopic thoracic sympathectomy (ETS) to block the sympathetic nerve. An operation of ETS in combination with clipping was performed. The skin perfusion pressure of the left radialis indicis was elevated soon after the sympathetic block was established during operation. Buerger's disease tends to cause stenosis in the peripheral artery, resulting in the off-label indication of angioplasties. We encountered a case of Buerger's disease that improved after treatment with sympathetic block via ETS in combination with clipping, without any side effects. We evaluated the effectiveness of sympathetic block using clipping as an alternative therapy for Buerger's disease in an upper limb.

Journal

  • Nishi Nihon Hifuka

    Nishi Nihon Hifuka 79 (1), 28-33, 2017

    Western Division of Japanese Dermatological Association

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