Thoracoscopic sympathectomy for ischaemic lesions related to bleomycin therapy for acquired immune deficiency syndrome-related Kaposi's sarcoma

Introduction capillary microscopy disclosed few signs of aspecific microangiopathy. No angiography was performed. Bleomycin treatment was discontinued and the Raynaud’s syndrome may be observed in HIV infected patient was treated with topical trinitrate which patients, mainly in patients treated with bleomycin resulted in a slow improvement after 1 year of followfor acquired immune deficiency syndrome-related up. Thereafter, his treatment included consecutive Kaposi’s sarcoma. This complication has been preinterferon (March–April 1994), adriamycin and velbe viously reported to occur in 10% of these patients. (two cycles in June and July 1994), radiotherapy of It may lead to disabling digital ischaemia with necrosis the proximal left thigh where several Kaposi’s lesions which may be difficult to treat in weakened patients. appeared with significant oedema (October 1994), We successfully treated such a patient with thoracodaunoxome (from May 1996 to January 1997), VP scopic sympathectomy. 16 (August 1996 to January 1997), velbe and oncovin (from January 1997) and triple antiretroviral combination. The patient was readmitted in October 1996 Case Report after he suffered an acute onset of coldness with cyanosis and pain involving all fingers of the right A 41-year-old homosexual man was admitted in hand. The radial pulse was palpable but ulnar pulse October 1996 for severe ischaemia of the right hand. was absent. Arteriography of the right upper limb He had been found HIV-1 positive in 1986, and had showed a segmental occlusion of the radial artery developed a cutaneous Kaposi’s sarcoma in July at the level of the wrist, occlusion of the ulnar artery 1992. After failure of zidovudine and interferon at the forearm, and multiple occlusions of the therapy, he had been treated with bleomycin in interdigital arteries with a lack of vascularisation of January 1993 and developed after three cycles (cumuthe index (Fig. 1). The symptoms did not regress lative dose of bleomycin: 120 mg) a typical Raynaud’s after 6 days of treatment with daily infusions phenomenon on both hands occurring every day, of 2.5 mg/kg heparin and 6 mg piribedil. A right mainly after cold exposure. All pulses were palpable. thorascopic dorsal sympathectomy extended from T2 Coagulation tests including antiphospholipid antito T4 was performed. The patient immediately bodies, protein C and protein S were normal. Nailfold improved after the operation with rewarming of the fingers, and was discharged on the third post∗ Please address all correspondence to: D. N. Chakfe, Department operative day. Six months later, the patient remained of Cardiovascular Surgery, Les Hopitaux Universitaires de Strasasymptomatic but described compensatory sweating bourg, 1, place de l’Hopital, BP n 426, 67091 Strasbourg Cedex, France. of the right shoulder.