Sympathectomy for thrombangiitis obliterans of the hands (Buerger’s disease)

Thrombangiitis obliterans (Buerger's disease) is an inflammatory, occlusive disease, which commonly affects the small- and medium-sized extremity vessels. The precise etiology of this, especially in Europe rare disease, is unknown; however there is a strong correlation to the use of tobacco. Up to now no standardised medical treatment exists and surgical revascularization is generally ruled out. We present two young smokers, suffering from finger tip necrosis. In both cases medical treatment failed and amputation was supposed to be done. Ischemic ulcers healed after thoracoscopic sympathectomy in one case; the fingers of the other patient, who continued smoking, had to be amputated. Sympathectomy is an effective treatment option for pain at rest and ischemic ulcers if medical treatment failed. The decisive prognostic factor is the successful therapy of tobacco dependence; surgeons should consider this as important as the operative treatment.