| 摘要 |
A 76-year-old female patient with a diagnosis of chronic perjpheral arteriosclerosis obliterans (PAO) due to long term abuse of corticosteroid had presented with acute vasospastic symptoms of coldness, cyanosis, ulcerations and rest pain of her four limbs for three days. On admission, angiographic findings showed severe vasculitis and arteriosclerotic change of her femoral, popliteal, posterior tibial, radial as well as ulnar arteries. Medical trial didn't show any improvement. After careful evaluation to see no possibility of angioplasty or revascularization, she was scheduled for two divided procedures including bilateral T2-T3 and L1-L3 sympathectomies using an endoscope. All toes were preserved and progressive dry gangrene changes of seven out of ten ischemic fingers were observed. Tehy underwent spontaneous autoamputation during a period of ten months, therefore, avoided the unnecessary surgical amputation. The authors recommend that endoscopic sympathectomy may serve as a good choice for such patients. The phenomenon of autoamputation will provide an alternative management for dry gangrene in selected cases if they are painless, infection-free and confinded to the terminal portion of digit. |
