Surgical treatment for Buerger's disease is controvertsial. Sympathectomy is considered the effective choice for healing ulcers and relieving pain, especially in the case of upper limb involvement. However, the rate of success is unpredictable and some patients require further treatment because of the recurrence of pain after operation. Distal bypass procedures are rarely feasible in such patients, because it is difficult to find the proper target artery to anastomose the grafted vessel.
We attempted to perform distal bypass in such a patient who had severe pain after sympathectomy by performing sympathectomy on the target artery so as to obtain proper outflow in the hand area.
