Distal brachial-radial artery bypass with periarterial sympathectomy in Buerger disease: a case report

Thromboangiitis obliterans (TAO), or Buerger disease, is an inflammatory vasculopathy affecting small- and medium-sized vessels. Surgical options for ischemia are often limited due to the distal nature of disease and the lack of suitable bypass targets. We present a case of upper extremity ischemia secondary to TAO treated with distal brachial-to-radial artery bypass and periarterial sympathectomy. A 46-year-old woman with a history of tobacco use presented with progressive left-hand pain, numbness, and diminished distal pulses in the extremity. Angiography demonstrated occlusion of the distal brachial artery with segmental occlusions of the radial and ulnar arteries and reconstitution of the palmar arch through the interosseous artery. Revascularization and sympathectomy resulted in initial symptomatic improvement. At 3-year follow-up, the patient reported continued avoidance of tobacco and sustained improvement in symptoms. Though smoking cessation is essential, arterial reconstruction combined with periarterial sympathectomy may provide symptom relief and improved tissue perfusion in TAO.