Sympathectomy: Indications, Procedure, and Complications

Sympathectomy interrupts sympathetic nerve fibers to treat autonomic overactivity.

Common Indications

• Palmar hyperhidrosis (thoracic sympathectomy T2–T3)
• Facial blushing (thoracic T2)
• Raynaud's phenomenon (lumbar L2–L3 or thoracic)
• Complex regional pain syndrome (CRPS)
• Refractory angina (historical)

Approach

Minimally invasive (VATS) or open. Nerves are clipped, cauterized, or resected. Outpatient common.

Risks

• Compensatory hyperhidrosis (most common, often truncal)
• Horner's syndrome (ptosis, miosis, anhidrosis) – from stellate ganglion injury
• Pneumothorax, neuralgia, recurrence

Patient selection and counseling on compensatory sweating are crucial.