Following periarterial
sympathectomy, patients with recurrent digital
ischemia due to vasospastic or vaso-occlusive disease have few remaining treatment options. We performed a retrospective review from 1997 to 2019 to determine the safety and efficacy of revision periarterial
sympathectomy. Eleven patients were identified who underwent revision periarterial
sympathectomy, performed on average 84 months after their initial procedure. Preoperatively, all patients had worsening ischemic
pain and five had non-healing
digital ulcers. Revision digital periarterial
sympathectomy alone was performed in seven patients, while four had a more extensive
sympathectomy. Mean follow-up after revision was 23 months (range 3 to 76). Eight patients had symptomatic improvement and four healed their
digital ulcers. Three patients developed new
ulcers during follow-up, of which two healed with
conservative management and one required three digital
amputations. Revision periarterial
sympathectomy is effective in providing symptomatic improvement and
digital ulcer healing with minimal postoperative complications.Level of evidence: IV.