Umar Usman, Muhammad Ulil Khaerul Takko

Successful management of upper limb Buerger's disease with video-assisted thoracoscopic sympathectomy: a case report

Introduction

Successful management of upper limb buerger's disease with video-assisted thoracoscopic sympathectomy: a case report . Discover a successful case of managing upper limb Buerger's disease with video-assisted thoracoscopic sympathectomy (VATS), an effective surgical treatment for severe symptoms.

Abstract

Introduction: Buerger's disease (BD) is an inflammatory disorder that specifically targets small- and medium-sized arteries in the extremities, resulting in pain. Despite the limited efficacy of many medicinal treatments, surgical interventions, such as video-assisted thoracoscopic sympathectomy (VATS), are frequently utilized. Case description: A 45-year-old male with a significant smoking history presented with recurring finger pain, bluish discoloration, and widespread ulcerations in the fourth digit of the left hand. The findings of Allen's test were positive as well. The patient fulfilled the diagnostic criteria for BD according to the VAS guidelines, with one major criteria (a history of active smoking) and four minor criteria (beginning of the disease before the age of 45, upper limb ischemia, migratory thrombophlebitis, and discoloration of the fingers). The choice to proceed with VATS was made because the symptoms persisted after oral medicine was administered. Conclusion: This therapy effectively treats BD and significantly reduces symptoms associated with insufficient blood flow. The ability of VATS to control sympathetic dysfunction suggests that it is a valuable treatment option.

Review

This case report presents a compelling account of successfully managing upper limb Buerger's disease (BD) using video-assisted thoracoscopic sympathectomy (VATS). The abstract clearly outlines a challenging clinical scenario where a patient with advanced BD symptoms, recalcitrant to conservative management, responded positively to a surgical intervention. Given the rarity and often debilitating nature of BD, particularly when affecting the upper limbs, reporting successful therapeutic strategies like VATS is highly valuable for the medical community. The concise summary immediately highlights the potential of VATS as an effective treatment option for symptomatic relief and improved perfusion in this patient population. The detailed description of the 45-year-old male patient's presentation, including recurring pain, bluish discoloration, widespread ulcerations, and a positive Allen's test, effectively establishes the severity and typical features of BD. The authors diligently applied the VAS diagnostic criteria, noting one major and four minor criteria, which strengthens the diagnostic certainty of the case. The decision to proceed with VATS only after oral medicine proved insufficient provides a clear rationale for the intervention, underscoring it as a targeted approach for refractory symptoms. The reported outcomes—significant reduction in symptoms associated with insufficient blood flow and effective control of sympathetic dysfunction—are encouraging and underscore the potential of VATS to address the underlying pathophysiology in selected cases. While this single case report offers promising insights into the utility of VATS for upper limb BD, it inherently carries the limitations of a case study, precluding broad generalization. Future reports or studies would benefit from including more detailed objective outcome measures, such as post-operative vascular assessments, long-term follow-up data on symptom recurrence, and quality of life indicators, to further solidify its efficacy. Nevertheless, this publication serves as a valuable clinical communication, reinforcing VATS as a viable and effective therapeutic option for carefully selected patients with upper limb Buerger's disease who have failed conventional medical management, contributing positively to the existing literature on this challenging condition.

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