Chronic Refractory Angina

Destructive Sympathectomy

Brief synopsis: The first report of an attempt to relieve angina by destruction of the cervical sympathetic chain was in 1916 by Jonnesco. Various surgical techniques were subsequently described, none of them providing a consistently successful outcome, presumably due to the acknowledged variations in cardiac innervation. In 1926 Swetlow described relief of angina following the paravertebral injection of alcohol into the first five thoracic dorsal nerve roots. This was accorded a success rate of between 50 and 75 per cent, although it was accompanied by a number of after-effects, such as burning pain, hyperaesthesia and anaesthesia, which would probably be considered unacceptable in modern practice.

As interest in the management of refractory angina  increases, this historic treatment is being re-examined. In specialist centres cardiothoracic surgeons have performed thoracoscopic diathermy of the upper thoracic sympathetic chain with promising results. However, more data are required before a full evaluation of this treatment can be made.

If sympathectomy fails

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