1. A comparative study of efficacy of Cervicodorsal sympathectomy versus Medical management in patients with upper limb Buerger’s disease with rest pain
Naqvi Sayyed SE1, Haseen MA2, Beg MH3
Department of CTVS, JawaharLal Nehru Medical College,
Aligarh Muslim University, Aligarh
1-Dr. Sayyed Ehtesham Hussain Naqvi, MS, MCh CTVS, DNB CTVS, Assistant professor
2- Dr. Mohd. Azam Haseen, MS, MCh CTVS, Associate professor
3-Prof. Mohd. Hanif Beg, MS, MCh CTVS, MNAMS, Professor

2. Authors hereby declare
No conflict of interest.
No funding source being involved, study being conducted in a government medical college.

3. INTRODUCTION Thromboangitis Obliterans
Non-atherosclerotic, segmental, inflammation affecting small and medium sized vessels of upper & Lower extremities.
differs from the more commonly encountered vasculitis.
inflammatory thrombus with relative sparing of the vessel wall.
Absent acute phase reactant (except during acute infarction)

4. INTRODUCTION varying prevalence rates among all causes of PAD
0.5% to 5.6% in USA & Western Europe
16% to 66% in Korea and Japan
45% to 63% in India
80% in Israel
Limb Involvement
Upper extremity (28%)
Lower extremity (46%)
Both (26%)
Pathogenesis
Smoking, Genetics, Hypercoagulability, Endothelial Dysfunction, Immunologic Mechanisms

5. MATERIAL & METHODS Objectives
short term surgical outcomes over 3 years of CDS
Comparison of CDS with medical management
Patient Cohort
upper limb Buerger’s disease with rest pain (June 2012 to June 2015 surgical and Medical cohorts)
Parameters compared
Incidence of amputations (digital, hand, forearm) within 6 months of initiating treatment.
Non healing Ulcers existing after 6 months of treatment
Any reduction in dose of analgesics after 1 months of initiating treatment.

6. MATERIAL & METHODS Treatment Given Medical Group Surgical Group
Quit Smoking
Oral Paracetamol 10mg/kg TDS
Oral Tramadol 1mg/kg TDS
Aspirin 1.5mg/kg OD
Pantoxyfilline 2mg/kg TDS
Cilastozol 8mg/kg TDS
Antibiotic as per pus culture & Sensitivity
Surgical Group
Cervicodorsal Sympathectomy (open ) plus
Medical management as in Medical group

7. PEROPERATIVE & POST OPERATIVE PHOTOGRAPHS OPEN CERVICODORSAL SYMPATHECTOMY

8. OBSERVATIONS Surgical Group N=30 Medical Group N=40 Managed Group N=70
Average Age
46 (28-51)
44 (27-49)
Sex
M= 26, F=4
M= 29, F= 11
M= 55, F=15
Smokers
28/30 (Bidi 24, Bidi + Cigg. 4)
40/40 (Bidi 28, Bidi + Cigg. 12)
68/70 (Bidi 52, Bidi + Cigg. 16)
Patients needing amputations
8/30 ( 26%)
Digital 6/8
Palmar 2/8
Forearm 0/8
28/40 (70%) p<0.05
Digital 18/28
Palmar 9/28
Forearm 1/28
36/70 (51.4 %)
Digital 24/28
Palmar11/28

9. OBSERVATIONS Surgical Group N=30 Medical Group N=40 Managed Group N=70
Incidence
Non healing Ulcers
1/30 (3%)
12/40 (30%)
P<0.05
13/70 (18.5%)
Reduction in analgesic (1 month)
15/30 (50%)
18/40 (45%)
P=0.15
33/70 (82%)
Cessation of Analgesic (6 month)
8/30 (26.6%)
6/40 (15%)
P=0.023
14/70 (20%0

10. CONCLUSION
Early Cervical sympathectomy in patients with Upper limb Buerger’s Disease when combined with medical management
Reduces the rate of amputations
Reduces the uptake of analgesics
Reduces the incidence of non healing ulcers
May help in cessation of analgesics