surgical sympathectomy produces most of the retinal changes noted in the retina of an STZ-treated rat in a non-diabetic rat

Sympathectomy significantly increases gene and protein expression of iNOS, as well as levels of PGE2 and protein expression of PGE2-EP2 receptor subtype. Isoproterenol treatment for 6 h to human retinal endothelial cells grown in high glucose medium reduced iNOS protein expression, but had no effect on PGE2 levels or PGE2 receptor protein expression. iNOS expression was attenutated by stimulation with xamoterol, while BRL37344 had no effect, suggesting that the iNOS effects are mediated by beta1-adrenergic receptors. These results suggest that loss of sympathetic activity, as occurs in diabetes, results in an upregulation of iNOS and PGE2-EP2 receptor protein expression, as well as PGE2 levels. Isoproterenol stimulation of human retinal endothelial cells cultured in a hyperglycemic environment decreased iNOS expression with no change in PGE2 levels, suggesting that only iNOS expression is modulated by sympathetic neurotransmission in endothelial cells. Overall, these results further the idea that alterations in sympathetic neurotransmission may result in many of the changes noted in the retina of the STZ-treated rat.
http://www.ncbi.nlm.nih.gov/pubmed/17067575

Sympathectomy leading to an extracranial steal phenomenon

J Igloffstein and R Laas
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.
Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy.Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to an extracranial steal phenomenon.http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1027532

CERVICAL SYMPATHECTOMY AND CEREBROSPINAL FLUID PRESSURE: THEIR RELATIONSHIP TO BRAIN METABOLISM

http://www.ncbi.nlm.nih.gov/pubmed/14247422

. 

Factors Affecting Cerebral Blood Flow- Experimental Review: 

Sympathectomy, Hypothermia, CO2 Inhalation and Pavarine 

The cerebral spinal fluid pressure increased significantly (86.86 to 117.34) immediately after operation but returned to normal within 2 weeks.

Ann Surg. 1966 May;163(5):771-7.

Shackelford RT, Hegedus SA.

PMID: 5930460 [PubMed - indexed for MEDLINE]PMCID: PMC1477179

Effects of increased cerebrospinal fluid pressure on the blood flow and on the energy metabolism of the brain. An experimental study.

Zwetnow NN.

PMID: 4316893 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/4316893
Acta Physiol Scand Suppl. 1970;339:1-31

The effect of carotid ligation and cervical sympathectomy in guinea-pigs on the ascorbic acid content of the aqueous humour at varying plasma levels

http://www.ncbi.nlm.nih.gov/pubmed/12985402

increased substance P within the iris, reproducing the effects of sympathectomy

www.springerlink.com/index/XHN321575M3556G3.pdf

Chemical sympathectomy leads to lowering of aqueous humor production

GRAEFE'S ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY

Volume 200, Number 3, 223-226, DOI: 10.1007/BF01028537

Surgical Denervation of Ocular Sympathetic Afferents Decreases Local Transforming Growth Factor-β and Abolishes Immune Privilege

Mounting evidence points to a role for the sympathetic nervous system in suppressing inflammation. This role might be of specific relevance for immune privilege in the eye, where, sporadically, patients with denervated sympathetic fibers develop chronic inflammation.

Our results show that in the absence of functional sympathetic fibers, the eye loses its ability to prevent either the immune rejection of intraocular allogeneic tumor cells or the suppression of delayed type hypersensitivity responses against soluble antigens injected in the anterior chamber. This loss of immune privilege is accompanied by a decrease in the concentration of transforming growth factor-β in the aqueous humor. These results suggest that immune privilege is lost in the absence of a functional sympathetic innervation of the eye, allowing intraocular immune responses to become exaggerated. We conclude that ocular sympathetic nerves are critical for the generation and maintenance of immune privilege in the eye through the facilitation of local transforming growth factor-β production.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731140/

Cervical sympathectomy causes photoreceptor-specific cell death in the rat retina

Changes in the regulation of the vasculature of the eye may be related to some age-related ocular diseases. We have previously shown that loss of sympathetic innervation, as can normally occur with age, resulted in substantial vascular growth of the choroid. The current study was designed to determine whether changes induced by sympathetic denervation causes significant loss of photoreceptors and increased glial cell reactivity in the retina. Sympathetic denervation was performed followed by immunohistochemistry, TUNEL staining, and protein expression analysis to investigate photoreceptor loss. There was a significant reduction (30%) in photoreceptor numbers in the sympathectomized eye. This loss was due to apoptosis, as there was over a doubling in apoptotic cell numbers after sympathectomy. This loss of photoreceptors in the sympathectomized eye resulted in a significantly reduced width of the outer nuclear layer of the retina when compared to the contralateral eye. Increased glial fibrillary acidic protein (GFAP) staining was also noted after sympathectomy in the ganglion cell layer with streaking toward the bipolar cell layer. These results suggest that loss of sympathetic innervation may cause significant changes to the physiology of the choroid.

Autonomic Neuroscience
Volume 120, Issues 1-2, 15 June 2005, Pages 46-51 

morphological changes in the retina noted after sympathectomy

Results: Mice treated with PDGF inhibitor AG 1296 showed an inhibition of corneal neovascularization and a reduction of pericytes in the new formed vessels compared to untreated animals. 

Retina from sympathectomized eyes receiving saline treatment had significantly  reduced PEDF mRNA and protein expression relative to the contralateral eye receiving saline treatment. These results are similar to previous work and indicate that injection alone did not alter the results. Intravitreal PEDF administration to sympathectomized eyes returned both mRNA and protein levels to those of the contralateral eye. PEDF administration also normalized retinal morphometry to prevent the sympathectomy-induced increases 

in capillary density of the outer plexiform layers, as well as the ganglion cell layer. 

Conclusions: These results suggest that one injection of PEDF can restore protein and mRNA 

levels to those noted in an untreated animal. Furthermore, these results also indicate that 

one injection of PEDF can reverse the morphological changes noted after sympathectomy 

in the retina. 

CR:  J.J. Steinle,  B.L. Lashbrook,

files.abstractsonline.com/SUPT/25/1421/SessionPDF/119.pdf

acute mesenteric ischemia and massive intestinal infarction secondary to bilateral lumbar sympathectomy

A case of acute mesenteric ischemia and massive intestinal infarction secondary to bilateral lumbarsympathectomy and without any other apparent precipitating factors is presented. Its characteristics and findings significantly agree with those described as part of the mesenteric arterial steal syndrome. Although this syndrome was originally described as secondary to surgical revascularization of the lower extremities, experimental studies have shown that lumbar sympathectomy, by means of reducing the peripheral vascular resistance in the lower extremities, similarly causes intense hemodynamic alteration of the mesenteric circulation due to the sudeen redistribution of blood flow to the lower limbs at the expense of the mesenteric flow. When marginally compensated occlusive mesenteric arterial disease exists prior to surgery, the sudden fall in the arterial pressure gradients in this vessel can precipitate the occlusion of these arteries, resulting in mesenteric ischemia and intestinal infarction. It has also been suggested that an intense vasospamodic neurogenic reflex in the mesenteric arteries is an important factor in the pathogenesis of this syndrome.
http://www.curehunter.com/public/pubmed536170.do

sympathectomy led to an exacerbation of colitis

Substance P (SP) is a pro-inflammatory neuropeptide in colitis, whereas sympathetic neurotransmitters are anti-inflammatory at high concentrations.

Results: In all layers, Crohn’s disease patients demonstrated a loss of sympathetic nerve fibres. Sprouting of SP⁺ nerve fibres was particularly observed in the mucosa and muscular layer in Crohn’s disease. SEMA3C was detected in epithelial cells, and there was a marked increase of SEMA3C-positive crypts in the mucosa of Crohn’s disease patients compared to controls. In Crohn’s disease, the number of SEMA3C-positive crypts was negatively related to the density of mucosal sympathetic nerve fibres. Sympathectomy reduced acute DSS colitis but increased chronic DSS colitis. Sympathectomy also increased chronic colitis in Il10^−/−mice.

Gut 2008;57:911-921 doi:10.1136/gut.2007.125401

Secondary Effects of Sympathectomy - Disturbance of Sexual Function

If a portion of the autonomic nervous system is removed to modify a specific disease process, unrelated physiologic mechanisms will also be affected. The degree to which these other mechanisms may be affected often governs the selection of operative procedures. The results produced by interfering with mechanisms other than those for which the operation is performed might be designated as side-effects or secondary effects. . . .

N Engl J Med 1951; 245:121-130July 26, 1951

http://www.nejm.org/doi/full/10.1056/NEJM195107262450401

Massive intestinal infarction following retroperitoneoscopic right lumbar sympathectomy

We describe a fatal case of intestinal infarction following an elective retroperitoneoscopic right sympathectomy. 
J Minim Access Surg. 2006 December; 2(4): 222–223.

Mesenteric arterial steal syndrome secondary to bilateral lumbar sympathectomy.

A case of acute mesenteric ischemia and massive intestinal infarction secondary to bilateral lumbar sympathectomy and without any other apparent precipitating factors is presented. Its characteristics and findings significantly agree with those described as part of the mesenteric arterial steal syndrome. Although this syndrome was originally described as secondary to surgical revascularization of the lower extremities, experimental studies have shown that lumbar sympathectomy, by means of reducing the peripheral vascular resistance in the lower extremities, similarly causes intense hemodynamic alteration of the mesenteric circulation due to the sudeen redistribution of blood flow to the lower limbs at the expense of the mesenteric flow. When marginally compensated occlusive mesenteric arterial disease exists prior to surgery, the sudden fall in the arterial pressure gradients in this vessel can precipitate the occlusion of these arteries, resulting in mesenteric ischemia and intestinal infarction. It has also been suggested that an intense vasospamodic neurogenic reflex in the mesenteric arteries is an important factor in the pathogenesis of this syndrome.

http://www.ncbi.nlm.nih.gov/pubmed/536170

after unilateral sympathectomy found that his previous and customary sensation of shivering while listening to a stirring passage of music occurred in only one side

Sweet* has reported the case of a very intelligent patient, the dean of a graduate school, who after a unilateral sympathectomy to treat his upper limb hyperhidrosis, found that his previous and customary sensation of shivering while listening to a stirring passage of music occurred in only one side and he could not be thrilled in the sympathectomized half of his body. These cases were interesting because emotions are usually experienced in a rather diffuse and bilateral fashion unless innervation has been specifically interrupted. (p.134.)
Jose M.R. Delgado, M.D.
Physical control of the mind,
Harper Torchbooks, Harper & Row Publishers, 1971

*Sweet, W.H. Participant in "Brain Stimulation in Behaving Subjects". Neurosciences Research Program Workshop. Dec. 1966

sympathectomy controversial

This is a field in which the unknown is still substantial and the some of the known -  controversial.
M. Hashmonai, 2005
President of the International Society of Sympathetic Surgery

CLINICAL AUTONOMIC RESEARCH

Volume 15, Number 2, 130-145, DOI: 10.1007/s10286-005-0271-x

The role of sympathectomy to treat RSD/CRPS is controversial and in some cases, the procedure worsens symptoms

http://www.neurologychannel.com/rsd/treatment.shtml

Autonomic determinism: the modes of autonomic control, the doctrine of autonomic space, and the laws of autonomic constraint

Contemporary findings reveal that the multiple modes of autonomic control do not lie along a single continuum extending from parasympathetic to sympathetic dominance but rather distribute within a 2-dimensional space. The physiological origins and empirical documentation for the multiple modes of autonomic control are considered. Then a formal 2-dimensional conception of autonomic space is proposed, and a quantitative model for its translation into a functional output surface is derived. It is shown that this model (a) accounts for much of the error variance that has traditionally plagued psychophysiological studies, (b) subsumes psychophysiological principles such as the law of initial values, (c) gives rise to formal laws of autonomic constraint, and (d) has fundamental implications for the direction and interpretation of a wide array of psychophysiological studies.
http://www.ncbi.nlm.nih.gov/pubmed/1660159?dopt=Abstract

Chemical sympathectomy impairs bone resorption in rats: a role for the sympathetic system on bone metabolism

http://www.ncbi.nlm.nih.gov/pubmed/10574574?dopt=Abstract

Neuroendocrine regulation of autoimmune/inflammatory disease

http://www.ncbi.nlm.nih.gov/pubmed/11375112?dopt=Abstract

"Predisposing factors to RSD include trauma, peripheral nerve injury"

Emergency orthopedics: the extremities - Google Books Result

Robert Rutha Simon, Steven J. Koenigsknecht - 2001

sympathectomy may result in the loss of a trophic influence which is important in the regulation of osteogenesis

Grain counts over periosteal osteoblasts of the femoral diaphysis and osteoblasts mesial to the first molar in the mandible demonstrated a significantly reduced uptake of ³H-proline in the sympathectomized rats. The data provide direct evidence of sympathetic influence on osteoblastic activity and suggest that sympathectomy may result in the loss of a trophic influence which is important in the regulation of osteogenesis.

Cell and Tissue Research

Volume 216, Number 1, 215-220, DOI: 10.1007/BF00234556

Progressive facial hemiatrophy following cervical sympathectomy

Unilateral cervical sympathectomy of the month-old rat produced a condition simulating progressive facial hemiatrophy during a postoperative period of 2–4 months. While the gross extent of the lesion produced varied, the histological appearance was uniform; adipose tissue alone was diminished. Osseous, muscular and vascular structures of the facial skull appeared unaltered under these experimental conditions. No evidence of a neurotrophic influence on either the growth or maintenance of bone form was found. The mechanism of production of the adipose atrophy remains unknown.
Archives of Oral Biology
Volume 1, Issue 3, January 1960, Pages 254-258, IN11-IN14 

defects in cartilage after sympathectomy

Profound degenerative changes occur in skeletal muscle following interruption of it's nerve supply and it has therefore been quite reasonably concluded that the motor nerves exert a definite trophic influence over striated muscle (Tower, 1939). However in the case of bone innervation, one is dealing with a quite different phenomenon.

Influence of the nervous system on bone and joints

1. Kendall B. Corbin,
2. Joseph C. Hinsey

Article first published online: 3 FEB 2005

unavoidable side effects and unforeseeable and unacceptable complications

Most of the difficulties associated with hyperhidrosis surgery are due to unavoidable side effects and unforeseeable and unacceptable complications. Careful patient selection is important before surgery so surgeons can avoid some of these pitfalls. Patients should also be fully informed of all potential side effects and complications before surgical treatment.
http://www.ncbi.nlm.nih.gov/pubmed/18557592

symptoms of Autonomic Neuropathy closely resemble the symptoms described by many who have undergone sympathectomy

This is not unexpected. Autonomic Neuropathy is due to damage to the ANS. Sympathectomy is a surgical destruction of the sympathetic chain (part of the chain) either by cutting or clamping  - a surgery that can result in a deranged functioning of the ANS. Surgeons are allowed to market sympathectomy  as an elective (life-style) procedure, often misrepresented as a 'cure' by the ETS surgeons. Autonomic neuropathy:
"Cardiovascular symptoms: exercise intolerance, fatigue, sustained heart rate, syncope, dizziness, lightheadedness, balance problems
Gastrointestinal symptoms: dysphagia, bloating, nausea and vomiting, diarrhea, constipation, loss of bowel control
Genitourinary symptoms: loss of bladder control, urinary tract infection, urinary frequency or dribbling, erectile dysfunction, loss of libido, dyspareunia, vaginal dryness, anorgasmia
Sudomotor (sweat glands) symptoms: pruritus, dry skin, limb hair loss, calluses, reddened areas
Endocrine symptoms: hypoglycemic unawareness
Other symptoms: difficulty driving at night, depression, anxiety, sleep disorders, cognitive changes" http://www.aafp.org/afp/2005/0601/p2123.html

We disagree that surgery and botulinum toxin are treatments of choice in severe cases of hyperhidrosis

The truth is exactly the opposite. Surgery is only rarely necessary, and the editorial quite properly warns of numerous surgical pitfalls, which include recurrence of hyperhidrosis, almost certain impotence, compensatory sweating, permanent neurological damage from anoxia, and death (their words). Botulinum toxin, which they recommend for axillary or plantar hyperhidrosis, requires 12 injections per axilla and 24-36 injections per foot. Even this horrendous procedure gives only 11 months' relief, and antibody formation may reduce long term efficiency.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118569/

Iontophoresis should be tried before other treatments

Iontophoresis is easy to perform, effective in about 90% of patients in two studies with 54 and 30 participants, free of hazardous side effects, and well accepted by almost all patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118569/

the Kuntz nerve played no part in the success or failure of ETS surgery

If you research the topic of ETS, you will come across various claims and counter-claims about the importance or otherwise of the Kuntz nerve. The Kuntz nerve is a small nerve fibre sometimes seen on the second rib not far from the main sympathetic chain. Its function is not known in humans. Some web-sites on ETS claim success rates of up to 100% for facial blushing because they search for and destroy the Kuntz nerve(s). These same people also claim to be able to correct failed ETS operations by reoperating and destroying the Kuntz nerve.
At the meeting of the International Society for Sympathetic Surgery in Germany, May 2003, attended by a majority of the world’s experts in ETS surgery (including us), all but one of the surgeons present were of the opinion that the Kuntz nerve played no part in the success or failure of ETS surgery for facial blushing. We share this majority opinion.
www.lapsurgeryaustralia.com.au

"Sympathectomy is a technique about which we have limited knowledge, applied to disorders about which we have little understanding."

Harald Breivik
Professor og avdelingsoverlege
Anestesiavdelingen, Rikshospitalet
http://www.pfizer.no/templates/Page____886.aspx

POSTSYMPATHECTOMY PAIN AND CHANGES IN SENSORY NEUROPEPTIDES

Postsympathectomy limb pain, postsympathectomy parotid pain, and Raeder's paratrigeminal syndrome are pain states associated with the loss of sympathetic fibres and in particular with postganglionic sympathetic lesions. There is a characteristic interval of about 10 days between surgical sympathectomy and onset of pain. It is proposed that this pain in man is correlated with the delayed rise in sensory neuropeptides seen in rodents after sympathectomy. These chemical changes probably reflect the sprouting of sensory fibres and may result from the greater availability of nerve growth factor after sympathectomy. The balance between the sensory and sympathetic innervations of a peripheral organ may be determined by competition for a limited supply of nerve growth factor.
The Lancet, Volume 326, Issue 8465, Pages 1158 - 1160, 23 November 1985

Following sympathectomy the basal t-PA activity in plasma was 70% less than controls

Following sympathectomy: (i) the basal t-PA activity in plasma was 70% less than controls (2.92 ± 1.96 versus 9.33 ± 1.72 IU/ml;P ≤ 0.001); (ii) the acute release from isolated vessels induced by bradykinin or phenylephrine was comparably reduced; and (iii) the greatest reductions occurred in densely innervated small vessel explants. The results provide new support for an autonomic regulation of neural t-PA release into the vessel wall matrix and blood of densely innervated thin-walled microvessels.

Blood Coagulation & Fibrinolysis:

September 2002 - Volume 13 - Issue 6 - pp 471-481

reparative dentin formation was reduced after sympathectomy

Textbook of Endodontology, By Gunnar Bergenholtz, Preben Hørsted-Bindslev, Claes Reit

John Wiley and Sons, 2009

link between sympathectomy and osteoclast-mediated bone resorption

Recent investigations have demonstrated a link between sympathectomy and osteoclast-mediated bone resorption. The exact nature of this link, however, is unknown, We hypothesize that substance P, a potent vasoconstrictive neuropeptide found in peripheral sensory fibers, including those innervating bone, is the mediator of this phenomenon. To test this theory, the effects of substance P on in vitro calcium release from cultured neonatal mouse calvaria were assessed. In addition, an in vivo study was conducted whereby gerbils were injected with capsaicin to eliminate substance P-containing fibers before sympathectomy with 6-hydroxydopamine. If the effects of 6-hydroxydopamine were eliminated by prior administration of capsaicin, the role of sensory nerves in sympathectomy-induced resorption would be strongly implicated.


The results indicate that substance P is capable of inducing resorption and that substance P-containing sensory nerves are required for the induction of resorption after sympathectomy in the gerbil.

Otolaryngol Head Neck Surg November 1, 1995 vol. 113 no. 5 569-581

diabetic autonomic neuropathy is due to a lesion of the sympathetic nerve supply to the skin

"We conclude that the diabetic anhidrotic syndrome, a form of diabetic autonomic neuropathy, is due to a lesion of the sympathetic nerve supply to the skin."

Diabetologia

Volume 22, Number 2, 96-99, DOI: 10.1007/BF00254836

Sympathectomy IS a (surgically caused) lesion of the sympathetic nerve supply to the skin 

The practice of surgical and chemical sympathectomy for neuropathic pain and CRPS is based on very little high quality evidence

Sympathectomy should be used cautiously in clinical practice, in carefully selected patients, and probably only after failure of other treatment options.
This review is an update on 'Sympathectomy for neuropathic pain' originally published in Issue 2, 2003.
Cochrane Database Syst Rev. 2010 Jul 7;(7):CD002918.

Cardiovascular collapse developing during thoracoscopic thoracic sympathectomy

Cardiovascular collapse developing during thoracoscopic thoracic sympathectomy in a patient with essential palmar hyperhidrosis: A case report.  
Park SJ, Jee DL.

Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea. djee@medical.yeungnam.ac.kr

Thoracoscopic thoracic sympathectomy (TTS) is usually a safe and uncomplicated procedure for treating essential palmar hyperhidrosis. However, we report a case of cardiovascular collapse that developed in a healthy patient undergoing TTS. The surgeon performed the left sympathectomy without incident. However, scarcely had an incision been made in the skin of the right chest when the patient developed sinus bradycardia and sudden, severe hypotension. Pulseless ventricular tachycardia occurred immediately thereafter, which rapidly progressed to ventricular fibrillation and cardiovascular collapse. The patient required resuscitation with 200 J of direct current shock defibrillation along with an intravenous injection of epinephrine 1 mg. She recovered without sequelae. We believe the Bezold-Jarisch reflex was triggered by pooling of venous blood and surgical stimuli, and the patient developed cardiovascular collapse as a result.

cervical sympathectomy for sexual dysfunction?

Use of stellate ganglion block for the treatment of sexual dysfunction

If the claims of the hundreds of ETS/ESB surgeons is true, than cervical or thoracic sympathectomy affects a well controlled, and limited area of the upper extremity (the hands only) to 'eliminate the overactive nerves that supply the sweat glands', - then this 'invention' registered by Lipov should be dismissed. 


Lipov here claims to prove systemic effect of the cervical procedure that will influence sexual function. Is he finally asserting what so many patients are saying and so many surgeons keep denying, that:
a: interference with the upper sympathetic chain elicited systemic changes of the nervous system
b: interference with the upper thoracic chain affected (also) sexual function - which was not beneficial to the patient. Indeed, retrograde ejaculation can be found in studies describing adverse effects of sympathectomy.
http://www.freepatentsonline.com/y2006/0286132.html

'Sweating surgery' controversy

There is tremendous controversy surrounding ETS. While prestigious medical boards such as the Society of Thoracic Surgeons fully support it, the National Institutes of Health considers ETS to be a "nerurocardiologic disorder", and NIH studies ETS patients as part of their protocol for autonomic failure. There is much disagreement among ETS surgeons about the best surgical method, opitimal location for nerve destruction, and as to the nature and extent of the consequent side effects. The internet now features many websites run by surgeons extolling the benefits of ETS backed by happy patient testimonials. However, there are also many websites run by disabled ETS victims who complain of severe complications and lack of adequate informed consent. Several online discussion forums are dedicated to the subject of ETS surgery, where both positive and negative patient testimonials abound.
http://www.wordiq.com/definition/Sympathectomy

FACTORS CONTRIBUTING TO SYMPATHECTOMY FAILURE

1. Sympathectomy is analogous to the act of killing the messenger. The sympathetic nervous system has the critical job of properly controlling and preserving the circulation in different parts of the body, especially in the extremities. By paralyzing the system, the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation.

Sympathectomy is similar to permanently removing the central heat and air-conditioning system and never replacing it because of malfunction.

Sympathectomy permanently damages the temperature regulatory system. The reason sympathectomy does not cause side effects other than ineffective control of pain as well as impotence and orthostatic hypotension is because it is invariably partial and incomplete.

2. Even after "complete" removal of the sympathetic plexus for the upper or lower extremities, the sympathetic nerves in the wall of the blood vessels are left intact.

3. As shown in Table 6, the most common form (over 80%) of RSD is disuse RSD. In this situation, the sympathetic system is temporarily hyperactive. Proper conservative treatment would prevent any unnecessary invasive surgery (such as sympathectomy) in such patients.

4. Usually the patients that end up needing sympathectomy are the ones who suffer from ephaptic dystrophy. Sympathectomy in such cases cause a classic Cannon phenomenon. This physiological phenomenon refers to the fact that the end organ that is controlled by sympathetic nerve fibers  will become uninhibited in its chemical dysfunction. As a result, even though the sympathetic fibers are not contributing to acetylcholine or become uninhibited with resultant increase of pain input.

In diabetic neuropathy RSD, sympathectomy dramatically relieves the pain for the first 1 to 3 years. Then deafferentation can Cannon phenomenon set in. As a result, invariably by the second to fifth year the patient ends up with a lot more pain. Sympathetic blocks repeated every 6 to 12 months yield similar results.

In patients who have had sympathectomy, thermography shows an increase of temperature  in the focus of ephaptic nerve damage (Cannon phenomenon) with secondary increase of pain and discomfort.

H. Hooshmand, M.D., Neurological Associates 

In 70 % compensatory sweating severe, recurrence rates were 15% and 19% at 1 and 2 years after surgery

In T2 and T3 resection, all patients experienced Compensatory Sweating and over 70% of the patients felt it was severe. Even in T2 resection, 90% of patients experienced CS and in 50% of these it was severe. High rates of CS are reported in Asian countries with hot and humid climates.

In T2 resection, recurrence rates were 15% and 19% at 1 and 2 years after surgery.It was not rare for a patient to experience recurrence more than 3 years after surgery.
Motoki Yano, MD, PhD and Yoshitaka Fujii, MD, PhD
Volume 138, Issue 1, Pages 40-45 (July 2005)

a strong association of autonomic dysfunction and impaired cerebral autoregulation

Furthermore, we found a strong association of autonomic dysfunction and impaired autoregulation indicated by a correlation between the LF/HF ratio and Sx (p < 0.001).

Drug and Alcohol Dependence
Volume 110, Issue 3, 1 August 2010, Pages 240-246

51% of the participants claimed that their quality of life decreased moderately or severely after sympathectomy

Pediatr Surg Int. 2008 Mar;24(3):343-7. Epub 2007 Nov 13.

Conditions arising after Sympathectomy

After stellate ganglion blockade: HORNER'S SYNDROME

• Drooping eyelid
• Constricted pupil (impaired vision in low light)
• Absent/reduced sweating one side of the face and head
• Redness of eyes
• Facial flushing
  

After regional sympathectomy: DUMPING SYNDROME:

• Rapid emptying of the stomach: lower end of small intestine fills too quickly
• Early dumping: nausea/vomiting/bloating/diarrhoea/shortness of breath
• Late dumping: 1-3 hours after eating: weakness/sweating/dizziness
• Both types may co-exist.

http://www.theaword.org/index.php?option=com_content&view=article&id=223:conditions-arising-after-sympathectomy&catid=84:the-sympathetic-nervous-system&Itemid=41

Surgical sympathectomy and primary autonomic insufficiency are other less common causes of

Dizziness in primary care patients

by EA Warner - 1992 - Cited by 25 - Related articles
Surgical sympathectomy and primary autonomic insufficiency are other less common causes of ... astigmatism can lead to dizziness. The dizziness is usu- ...
www.springerlink.com/index/W66Q5874VH0R17KH.pdf - Similar

Surgical sympathectomy is one of the causes or Orthostatic Hypotension

Causes of Orthostatic Hypotension

Peripheral

Amyloidosis

Diabetic, alcoholic, or nutritional neuropathy

Familial dysautonomia (Riley-Day syndrome)

Guillain-Barré syndrome

Paraneoplastic syndromes

Pure autonomic failure (formerly called idiopathic orthostatic hypotension)

Surgical sympathectomy

http://www.merckmanuals.com/professional/sec07/ch069/ch069d.html

Bilateral sympathectomy produced fatal heart block in a few of their experiments

Mendlowitz. Schauer, and Gross⁴ pointed out that the heart rate became slower after removal of the sympathetic chain, but this bradycardia was only temporary. Bilateral sympathectomy produced fatal heart block in a few of their experiments.

American Heart Journal
Volume 22, Issue 4, October 1941, Pages 545-548

bradycardia and other cardiac complications are common side effects?

The most common side effects of sympathectomy are compensatory sweating, gustatory sweating and cardiac changes including decreasing heart rate, systolic-diastolic and mean arterial pressure. The mechanism of bradycardia and other cardiac complications that develop after thoracic sympathectomy are still unclear.

http://tipbilimleri.turkiyeklinikleri.com/abstract_54802.html

"It is a lie that sympatholysis may specifically cure patients

with unqualified "reflex sympathetic dystrophy". This was already stated by the father of sympathectomy, Rene Leriche, more than half a century ago.
...it is not an error, but a lie. While conceptual errors are not only forgivable but natural to inexact medical science, lies, particularly when entrepreneurially inspired are condemnable and call for a peer intervention.

J. Neurology (1999) 246: 875-879

sympathectomy reduces fear - interferes with a range of emotional responses

"Experiements in animals demonstrate that sympathectomy may retard averse conditioning. (DiGusto and King, 1972), most likely because sympathectomy reduces fear."
Clinical Neuropsychology 2003

impairment of autoregulation after unilateral cervical sympathectomy

Although these findings argued against a neurogenic mechanism, James at al. (1969) reported impairment impairment of autoregulation after unilateral cervical sympathectomy in the babbon. Gotoh et al. (1971/1972) observed impairment of autoregulation in patients with the Shy-Drager syndrome.
It was concluded that the autonomic nervous system plays an important role in the mechanism of autoregulation of CBF and that his mechanism is independent of the chemical control of the cerebral vessels. This was confirmed by direct observation of the pial vessels in cats, where separate sites of action in the vascular tree for autoregulation and chemical control were demonstrated; the autoregulatory reaction was located in pial arteries with a diameter larger than 50 μ, and the reaction to carbon dioxide in pial arteries of smaller diameter (Gotoh et al. 1975).
They concluded that the arteries operating in autoregualtin were the larger ones with the dense innervation, while the smaller arteries with sparse innervation were involved in chemical control.
Coronna and Plum (1973) demonstrated the absence of CBF autoregulation in a patient with a Shy-Drager syndrome who had a postganglionic denervation....

Gotoh et al (1979) subsequently showed that autoregulation in patients with this syndrome was impaired irrespective of the localization of the damage to the cervical sympathetic nervous system (preganglionic, central, postganglionic) as judged by the eye instillation test.
Handbook of Clinical Neurology,

Vascular Diseases, Part I by P. J. Vinken, G. W. Bruyn, H. L. Klawans, and J. F. Toole

, Volume 53, Part 1

Elsevier Health Sciences, 1988