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Current Hypertension Reports Sep 2016The etiology of hypertension, a critical public health issue affecting one in three US adults, involves the integration of the actions of multiple organ systems,... (Review)
Review
PURPOSE OF REVIEW
The etiology of hypertension, a critical public health issue affecting one in three US adults, involves the integration of the actions of multiple organ systems, including the renal sympathetic nerves. The renal sympathetic nerves, which are comprised of both afferent (sensory input) and efferent (sympathetic outflow) arms, have emerged as a major potential therapeutic target to treat hypertension and disease states exhibiting excess renal sympathetic activity.
RECENT FINDINGS
This review highlights recent advances in both clinical and basic science that have provided new insight into the distribution, function, and reinnervation of the renal sympathetic nerves, with a focus on the renal afferent nerves, in hypertension and hypertension-evoked disease states including salt-sensitive hypertension, obesity-induced hypertension, and chronic kidney disease. Increased understanding of the differential role of the renal afferent versus efferent nerves in the pathophysiology of hypertension has the potential to identify novel targets and refine therapeutic interventions designed to treat hypertension.
Topics: Animals; Catheter Ablation; Humans; Hypertension; Kidney; Sympathectomy; Sympathetic Nervous System
PubMed: 27595156
DOI: 10.1007/s11906-016-0676-z -
Cardiology Journal 2022Pulmonary arterial hypertension (PAH) is a chronic pulmonary vascular disease characterized by increased pulmonary arterial pressure and pulmonary arterioles remodeling.... (Review)
Review
Pulmonary arterial hypertension (PAH) is a chronic pulmonary vascular disease characterized by increased pulmonary arterial pressure and pulmonary arterioles remodeling. Some studies have discovered the relationship between sympathetic nerves (SNs) and pathogenesis of PAH. This review is aimed to illustrate the location and components of SNs in the pulmonary artery, along with different methods and effects of pulmonary artery denervation (PADN). Studies have shown that the SNs distributed mainly around the main pulmonary artery and pulmonary artery bifurcation. And the SNs could be destroyed by three ways: the chemical way, the surgical way and the catheter-based way. PADN can significantly decrease pulmonary arterial pressure rapidly, improve hemodynamic varieties, and then palliate PAH. PADN has been recognized as a prospective and effective therapy for PAH patients, especially for those with medication-refractory PAH. However, further enlarged clinical studies are needed to confirm accurate distribution of SNs in the pulmonary artery and the efficacy of PADN.
Topics: Humans; Hypertension, Pulmonary; Prospective Studies; Pulmonary Arterial Hypertension; Pulmonary Artery; Sympathectomy
PubMed: 33438182
DOI: 10.5603/CJ.a2020.0186 -
The Journal of Thoracic and... Jan 2014
Topics: Female; Heart; Humans; Long QT Syndrome; Male; Sympathectomy; Tachycardia, Ventricular; Thoracic Surgery, Video-Assisted
PubMed: 24268957
DOI: 10.1016/j.jtcvs.2013.07.067 -
The Journal of Thoracic and... Jan 2014
Topics: Ablation Techniques; Female; Humans; Hyperhidrosis; Male; Sweating; Sympathectomy; Thoracoscopy; Umbilicus
PubMed: 24176275
DOI: 10.1016/j.jtcvs.2013.08.065 -
Circulation Research Mar 2019Despite availability of effective drugs for hypertension therapy, significant numbers of hypertensive patients fail to achieve recommended blood pressure levels on ≥3... (Review)
Review
Despite availability of effective drugs for hypertension therapy, significant numbers of hypertensive patients fail to achieve recommended blood pressure levels on ≥3 antihypertensive drugs of different classes. These individuals have a high prevalence of adverse cardiovascular events and are defined as having resistant hypertension (RHT) although nonadherence to prescribed antihypertensive medications is common in patients with apparent RHT. Furthermore, apparent and true RHT often display increased sympathetic activity. Based on these findings, technology was developed to treat RHT by suppressing sympathetic activity with electrical stimulation of the carotid baroreflex and catheter-based renal denervation (RDN). Over the last 15 years, experimental and clinical studies have provided better understanding of the physiological mechanisms that account for blood pressure lowering with baroreflex activation and RDN and, in so doing, have provided insight into which patients in this heterogeneous hypertensive population are most likely to respond favorably to these device-based therapies. Experimental studies have also played a role in modifying device technology after early clinical trials failed to meet key endpoints for safety and efficacy. At the same time, these studies have exposed potential differences between baroreflex activation and RDN and common challenges that will likely impact antihypertensive treatment and clinical outcomes in patients with RHT. In this review, we emphasize physiological studies that provide mechanistic insights into blood pressure lowering with baroreflex activation and RDN in the context of progression of clinical studies, which are now at a critical point in determining their fate in RHT management.
Topics: Animals; Antihypertensive Agents; Baroreflex; Blood Pressure; Catheter Ablation; Drug Resistance; Electric Stimulation Therapy; Equipment Design; Humans; Hypertension; Implantable Neurostimulators; Sympathectomy; Sympathetic Nervous System; Treatment Outcome
PubMed: 30920919
DOI: 10.1161/CIRCRESAHA.118.313221 -
Revista Do Colegio Brasileiro de... May 2019Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each... (Review)
Review
Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each patient, as well as the possible postoperative complications, are fundamental to obtain good results. Thus, we performed a review of articles from the PubMed database published between 2005 and 2019 that presented, as the main topic, thoracoscopy sympathectomy for the treatment of hyperhidrosis, with the objective of evaluating the current state of art referring to postoperative quality of life, surgical time and its complications. From this analysis, we verified the importance of the level of sympathetic ganglion chain section in relation to results. The complication, although occurring, did not reduced the postoperative level of satisfaction or patients' quality of life.
Topics: Humans; Hyperhidrosis; Operative Time; Patient Satisfaction; Postoperative Complications; Quality of Life; Sympathectomy; Thoracic Surgery, Video-Assisted; Treatment Outcome
PubMed: 31141034
DOI: 10.1590/0100-6991e-20192157 -
Annual Review of Physiology Feb 2021Heart failure (HF) is a global pandemic with a poor prognosis after hospitalization. Despite HF syndrome complexities, evidence of significant sympathetic overactivity... (Review)
Review
Heart failure (HF) is a global pandemic with a poor prognosis after hospitalization. Despite HF syndrome complexities, evidence of significant sympathetic overactivity in the manifestation and progression of HF is universally accepted. Confirmation of this dogma is observed in guideline-directed use of neurohormonal pharmacotherapies as a standard of care in HF. Despite reductions in morbidity and mortality, a growing patient population is resistant to these medications, while off-target side effects lead to dismal patient adherence to lifelong drug regimens. Novel therapeutic strategies, devoid of these limitations, are necessary to attenuate the progression of HF pathophysiology while continuing to reduce morbidity and mortality. Renal denervation is an endovascular procedure, whereby the ablation of renal nerves results in reduced renal afferent and efferent sympathetic nerve activity in the kidney and globally. In this review, we discuss the current state of preclinical and clinical research related to renal sympathetic denervation to treat HF.
Topics: Animals; Disease Progression; Heart Failure; Humans; Kidney; Sympathectomy
PubMed: 33074771
DOI: 10.1146/annurev-physiol-031620-093431 -
Journal of the American Society of... Oct 2021
Topics: Humans; Nephritis; Sympathectomy
PubMed: 34599032
DOI: 10.1681/ASN.2021060748 -
The Cochrane Database of Systematic... Sep 2013This review is an update of a review first published in Issue 2, 2003, which was substantially updated in Issue 7, 2010. The concept that many neuropathic pain syndromes... (Review)
Review
BACKGROUND
This review is an update of a review first published in Issue 2, 2003, which was substantially updated in Issue 7, 2010. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are "sympathetically maintained pains" has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain or by minimally invasive procedures using thermal or laser interruption.
OBJECTIVES
To review the evidence from randomised, double blind, controlled trials on the efficacy and safety of chemical and surgical sympathectomy for neuropathic pain, including complex regional pain syndrome. Sympathectomy may be compared with placebo (sham) or other active treatment, provided both participants and outcome assessors are blind to treatment group allocation.
SEARCH METHODS
On 2 July 2013, we searched CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database. We reviewed the bibliographies of all randomised trials identified and of review articles and also searched two clinical trial databases, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, to identify additional published or unpublished data. We screened references in the retrieved articles and literature reviews and contacted experts in the field of neuropathic pain.
SELECTION CRITERIA
Randomised, double blind, placebo or active controlled studies assessing the effects of sympathectomy for neuropathic pain and CRPS.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and validity, and extracted data. No pooled analysis of data was possible.
MAIN RESULTS
Only one study satisfied our inclusion criteria, comparing percutaneous radiofrequency thermal lumbar sympathectomy with lumbar sympathetic neurolysis using phenol in 20 participants with CRPS. There was no comparison of sympathectomy versus sham or placebo. No dichotomous pain outcomes were reported. Average baseline scores of 8-9/10 on several pain scales fell to about 4/10 initially (1 day) and remained at 3-5/10 over four months. There were no significant differences between groups, except for "unpleasant sensation", which was higher with radiofrequency ablation. One participant in the phenol group experienced post sympathectomy neuralgia, while two in the radiofrequency group and one in the phenol group complained of paraesthesia during needle positioning. All participants had soreness at the injection site.
AUTHORS' CONCLUSIONS
The practice of surgical and chemical sympathectomy for neuropathic pain and CRPS is based on very little high quality evidence. Sympathectomy should be used cautiously in clinical practice, in carefully selected patients, and probably only after failure of other treatment options. In these circumstances, establishing a clinical register of sympathectomy may help to inform treatment options on an individual patient basis.
Topics: Catheter Ablation; Complex Regional Pain Syndromes; Humans; Leg; Neck; Neuralgia; Phenol; Randomized Controlled Trials as Topic; Sympathectomy; Sympathectomy, Chemical; Sympatholytics; Thorax
PubMed: 23999944
DOI: 10.1002/14651858.CD002918.pub3 -
The Journal of Thoracic and... Oct 2018
Topics: Humans; Hyperhidrosis; Sympathectomy; Thoracic Surgical Procedures
PubMed: 30057188
DOI: 10.1016/j.jtcvs.2018.05.113