Pos1343 treatment of resistant raynaud’s phenomenon with single-port thoracoscopic sympathicotomy: one-year follow-up

BackgroundRaynaud’s phenomenon (RP) usually results in discoloration of the extremities when provoked by cold or emotional stress [1]. Some patients do not respond to conventional therapies, such as lifestyle interventions and vasodilatory medication. These patients are confronted with limited options for treatment. In a previous study we have shown that minimally invasive Single-Port Thoracoscopic Sympathicotomy (SPTS) objectively and subjectively improves treatment-resistant RP, after one month [2]. This procedure for treatment-resistant RP is minimally invasive and potentially highly effective, because it specifically targets the sympathetic nerve at the third rib (R3), while leaving the ganglia untouched [3]. The procedure was only performed on the left side in the pilot study, which objectively resulted in improvement of left-hand perfusion in all patients after one month, when compared to the right hand. Furthermore, patient satisfaction after surgery was high and RP attacks of the left hand were less frequent and of shorter duration. Previous studies have shown that long-term effects of conventional sympathectomy is stable in the long run in the majority of patients [4, 5]. We have previously published the one-month results of SPTS for treatment-resistant RP in a concise report [2]. In the current study we sought to report the one-year follow-up results of SPTS for treatment-resistant RP in the same cohort of patients.ObjectivesFollow-up of patients with treatment-resistant Raynaud’s phenomenon (RP) one-year after single-port thoracoscopic sympathicotomy (SPTS).MethodsEight patients (six males, two females, median age of 45 years) with treatment-resistant RP underwent left-sided SPTS at the third rib (R3), unilaterally. Perfusion was assessed with a cooling and recovery procedure at baseline and one year after SPTS. Furthermore, laser speckle contrast analysis, pulse wave velocity, heart rate variability and nailfold capillaroscopy were performed. In addition, questionnaires were taken, and number and duration of RP attacks were reported over a 2-week period.ResultsOne year after SPTS the duration of the attacks of was reduced with 1.9 hours in the left hand versus 0.9 hours in the right hand. Furthermore, three aspects of the questionnaire showed a significant improvement (role limitations due to physical health (p=0.017), pain (p=0.027) and physical functioning (p=0.025)). The total area under the curve of the total cooling and recovery procedure of the left hand was larger one year after surgery (101 (75–140) at baseline versus 118 (95–190) one year post-operatively, p=0.012), implying a better perfusion in the fingers. This was mainly due to the improvement during the recovery phase (21 (1–41) at baseline versus 38 (24–43) one year post-operatively, p=0.028).ConclusionOne year after unilateral R3 SPTS there is clear benefit with regard to the majority of outcome variables, though some effects seem to attenuate. Long-term effects and five-year follow-up results will be investigated in an on-going study.References[1]Herrick AL. The pathogenesis, diagnosis and treatment of Raynaud phenomenon. Nat Rev Rheumatol. 2012;8(8):469-79.[2]van Roon AM, Kuijpers M, van de Zande SC, Abdulle AE, van Roon AM, Bos R, et al. Treatment of resistant Raynaud’s phenomenon with single-port thoracoscopic sympathicotomy: a novel minimally invasive endoscopic technique. Rheumatology (Oxford). 2020;59(5):1021-5.[3]Kuijpers M, Klinkenberg TJ, Bouma W, DeJongste MJ, Mariani MA. Single-port one-stage bilateral thoracoscopic sympathicotomy for severe hyperhidrosis: prospective analysis of a standardized approach. J Cardiothorac Surg. 2013;8:216.[4]Coveliers HM, Hoexum F, Nederhoed JH, Wisselink W, Rauwerda JA. Thoracic sympathectomy for digital ischemia: a summary of evidence. J Vasc Surg. 2011;54(1):273-7.[5]Sayers RD, Jenner RE, Barrie WW. Transthoracic endoscopic sympathectomy for hyperhidrosis and Raynaud’s phenomenon. Eur J Vasc Surg. 1994;8(5):627-31.Disclosure of InterestsNone declared