Occurrence and multiple recurrence of severe vasospasm of the upper extremity following thorascopic sympathectomy for hyperhidrosis.

Abstract

Thorascopic sympathectomy is a widely used procedure for the treatment of intractable palmar hyperhidrosis. A 24-year-old woman who underwent thorascopic sympathectomy for hyperhidrosis in 2005 presented on more than 30 occasions with recurrent right distal upper limb ischaemia secondary to repetitive episodes of vasospasm. The patient did not have preoperative symptoms consistent with Raynaud's syndrome. We observed a reduction in the symptomatic relief offered by Iloprost treatment over a period of five years. This is the first report of distal upper limb ischaemia following thorascopic sympathectomy. We highlight the development of resistance to repeated Iloprost infusions that we observed in this case.