Effect of surgical sympathectomy in patients diagnosed with Thromboangiitis obliterans (TAO) compared to pharmacotherapy and bypass surgery.

Background: Thromboangiitis obliterans (TAO) is a type of vasculopathy that affects small and intermediate vessels of extremities. Common symptoms are intermittent claudication, rest pain, Raynaud phenomenon, ischemic ulcers, superficial thrombophlebitis. Therapeutic interventions include vasodilators, prostaglandin analogues (ILOPROST), antiplatelets, surgical sympathectomy and bypass surgery. Objectives: This prospective cohort study aimed to compare post-operative outcomes in patients with TAO that underwent surgical sympathectomy versus bypass surgery and pharmacotherapy. Method: 70 patients diagnosed with TAO were enrolled for the study. 37 patients with surgical sympathectomy,11 patients with amputation surgery, 15 patients with bypass surgery and 12 patients who received ILOPROST were evaluated in first day, 3 months, and 6 months follow up. Improvements of common complaints were recorded and the final results were compared. Result: Quit consumption of tobacco in any form is the fundamental treatment for Buerger disease, surgical sympathectomy and bypass surgery are helpful in patients with persistent pain and non-healing ischemic lesions that have abstained from consumption of tobacco. The final results showed that post-operative outcomes of patients underwent bypass surgery were significantly better than patients underwent sympathectomy and pharmacotherapy. Conclusion: Patients with TAO that suffer from severe symptoms, significantly benefit from Bypass surgery in short-term follow up but because of lack of proper runoff arteries and the nature of the occlusive thrombi, which are diffuse and mostly located in distal vessels, bypass surgery is often feasible and sympathectomy commonly are performed. pharmacotherapy with different medications can improve the symptoms but have no effects on preventing the disease from progression.