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Endoscopic transthoracic sympathectomy (ETS)

Report type: Alert
Published: 1999-08-30  Revised: 2002-09-30
Contact person: Jan Liliemark  E-mail: liliemark@sbu.se

Findings by SBU Alert

This is a translation of version 1 published on August 30, 1999. The latest version of this report is not available in English.

Endoscopic transthoracic sympathectomy (ETS) is used on a limited scale as a complement to traditional treatment methods for severe coronary heart disease. In patients where traditional methods do not help, or where the risk of, eg, coronary artery surgery is perceived to be excessive, ETS may be considered. However, experience with the procedure is limited, and only a few open studies on ETS have been conducted.

The findings by SBU Alert show that poor* evidence is available about ETS as regards side effects, risks, and short-term effects. There is no* scientific evidence demonstrating the long-term results of the method or its cost effectiveness in relation to other methods.

If the results from pilot studies are confirmed by current randomised studies, the method may prove to be a valuable alternative for patients in whom problems persist after traditional therapies have been unsuccessful. Until further notice, the method should be used only in a controlled way within the framework of scientific studies. An assessment should be carried out addressing treatment benefits in relation to the risks for side effects, direct healthcare costs, and socioeconomic effects.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Christer Wettervik, MD, Borås Hospital. It has been reviewed by Prof Åke Hjalmarsson, MD PhD, Sahlgrenska University Hospital.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

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  2. Lindgren, I. Angina pectoris, a clinical study with special reference toneurosurgical treatment. Thesis. Acta Med Scand, 1950:1-141.
  3. Birkett DA, Apthorp GH, Chamberlain DA, Hayward GW, Tuckwell EG. Bilateral upper thoracic sympathectomy in angina pectoris: results in 52 cases. Br Med J, 1965; 2:187.
  4. Claes G, Gothberg G. Endoscopic transthoracic electocautery of thesympathetic chain for palmar and axillary hyperhidrosis. Br J Surg, 1991;78:760.
  5. Claes G, Raf L. Biverkningar vanliga efter operation mot handsvett. Läkartidningen 1999;96(8):930-32.
  6. Meyerson B. Skonsammare alternativ till sympatikotomi önskvärt. Läkartidningen 1999;96(9):980-81.
  7. Tygesen H, Claes G, Drott C, Emanuelsson H, Lomsky M, Lurje L, Rådberg G, Wennerblom B, Wettervik C. Effects of EndoscopicTransthoracic Sympathicotomy on Heart Rate variability in Severe AnginaPectoris. Am J Cardiol 1997;79:1447-52.
  8. Tygesen H, Claes G, Drott C, Emanuelsson H, Lomsky M, Lurje L, Rådberg G, Wennerblom B, Wettervik C. Long-term Effect of Endoscopic Transthoracic Sympathicotomy on Heart Rate Variability in Severe Angina Pectoris Eur Heart J suppl 1997;18;93 (abstr).
  9. Wettervik C, Claes G, Drott C, Emanuelsson H, Lomsky M, Rådberg G, Tygesen H. Endoscopic transthoracic sympathicotomy for severe angina. Lancet, 1995; 345:97-98.
  10. Wettervik C, Claes G, Drott C, Emanuelsson H, Lomsky M, Rådberg G, Tygesen, H. Cardiac effects of thoracic sympathectomy Eur Heart J suppl, 1996;17;137 (abstr).
  11. Wettervik, opublicerade data.