Reflex sympathetic dystrophy--the surgeon's role in management.

It is important for vascular surgeons to be familiar with reflex sympathetic dystrophy because they may be called on to participate in the evaluation and treatment of patients with this syndrome. Over a 3 1/2-year period, 35 patients, initially evaluated by a team of pain experts, were referred for surgical sympathectomy for reflex sympathetic dystrophy. All patients had at least one positive diagnostic sympathetic block before they were considered for surgical sympathectomy. With use of this team approach and careful patient selection, excellent results were obtained in 74%, good results in 17%, and poor results in 9%. Three patients required a repeat cervical sympathectomy after initial surgery failed to relieve their symptoms. One patient required a contralateral lumbar sympathectomy after ipsilateral sympathectomy was unsuccessful. Better results were obtained in patients treated earlier in their course and with extended surgical sympathectomy. Patients not responding to initial sympathectomy should be evaluated for the presence of residual functional sympathetic tissue, and if this is identified, further sympathectomy by an alternate approach appears justified.