Is there any role of sympathectomy in Raynaud’s disease?

Sympathectomy was once considered to be the treatment of last resort for severe, refractory Raynaud's. Though severe Raynaud's remains a challenging disorder to manage, nowadays, sympathectomy rarely if ever enters the therapeutic discussion.

Though most patients with Raynaud's phenomenon observed an excellent immediate effect from sympathectomy, only a minority of them achieved a long lasting benefit. This has been borne out in several retrospective studies documenting considerable patient dissatisfaction with the procedure.

Hyperhidrosis, gustatory sweating and excessively dry palms have all been described following the procedure. A return of Raynaud's symptoms is also commonly noted.

In summary, this procedure should be removed from our ...

I still believe that there is a role, albeit limited, for digital sympathectomy. I do consider this in patients who have a critical ischemic event as one way to get them out of the crisis, if other strategies have failed or are not tolerated/accessible. This is not a good long-term treatment strategy as the results are temporary in most cases. You also have to have the availability of an experienced surgeon. But I do consider this in patients with threatened/ongoing ischemia and tissue loss.