CardioVascular and Interventional Radiology

, Volume 39, Issue 12, pp 1722–1727 | Cite as

CT-Guided, Ethanol Sympatholysis for Primary Axillary–Palmar Hyperhidrosis

  • Maria Tsitskari
  • Gerhard Friehs
  • Vassilis Zerris
  • Christos Georgiades
Clinical Investigation



Primary hyperhidrosis is an excessive sweating due to an overactive sympathetic system. Our objective was to test the feasibility and provide early data on the safety/efficacy of CT-guided sympatholysis, for primary hyperhidrosis.

Materials and Methods

Nine consecutive patients with axillary–palmar hyperhidrosis were treated between 2013 and 2015. CT-guided sympathetic block was performed in the outpatients at T-2, T-3, and T-4, bilaterally using alcohol under local anesthesia. Immediate postprocedure CT was obtained to assess the complications as per Common Terminology Criteria for Adverse Events, version 4. Technical success and clinical success were recorded. Primary and secondary efficacy were assessed by phone and clinical visits; mean follow-up was 12 months (6–26 months). Descriptive statistics was used to report the outcomes.


One procedure was aborted due to eyelid ptosis after lidocaine injection. All other eight patients (5:3, F:M) (median age 32) had immediate cessation of sweating. Two major complications (pneumothorax, one requiring a chest tube) occurred. Two patients recurred with unilateral and one with bilateral symptoms. One of the unilateral recurrence and the bilateral recurrence patients was retreated successfully. Median follow-up was 1 year. No cases of Horner’s or compensatory hyperhidrosis were observed.


CT-guided EtOH sympatholysis for axillary/palmar primary hyperhidrosis is feasible. Technical failure rate was 11 %. Primary and secondary efficacy are 75 and 94 %, respectively, to a median follow-up of 1 year. Risk profile appears favorable. Despite a small sample size, results confirm feasibility and encourage a larger study.


Hyperhidrosis Sympatholysis Sympathectomy 


Compliance with Ethical Standards

Conflict of interest

There authors declare no conflicts of interest.


  1. 1.
    Thorlacius L, Gyldenlove M, Zachariae C, Carlsen BC. Distinguishing hyperhidrosis and normal physiological sweat production: new data and review of hyperhidrosis data for 1980–2013. Int J Dermatol. 2015. doi: 10.1111/ijd.12822. [Epub ahead of print].
  2. 2.
    Grunfeld A, Murray CA, Solish N. Botulinum toxin for hyperhidrosis: a review. Am J Clin Dermatol. 2009;10(2):87–102.CrossRefPubMedGoogle Scholar
  3. 3.
    Canadian agency for drugs and technologies in health. Laser therapy for hyperhidrosis: A review of the clinical effectiveness and guidelines. 2015, PMID: 26180877.
  4. 4.
    Ong W, Lee A, Tan WB, Lomanto D. Long-term results of a randomized controlled trial of T2 versus T2-T3 ablation in endoscopic thoracic sympathectomy for palmar hyperhidrosis. Surg Endosc. 2015, PMID 26150222 [Epub ahead of print].Google Scholar
  5. 5.
    Horma Babana H, Lucas A, Marin F, Duvauferrier R, Rolland Y. Evaluation of the efficacy of CT guided thoracic sympatholysis to treat palmar hyperhidrosis French. J Radiol. 2004;85(1):21–24.Google Scholar
  6. 6.
    Glaser DA, Pariser DM, Hebert AA, Landells I, Somogyi C, Weng E, Brin MF, Beddingfield F. A prospective, nonrandomized, open-label study of the efficacy and safety of Onabotulinum toxin A in adolescents with primary axillary hyperhidrosis. Pediatr Dermatol. 2015;32(5):609–17.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lakraj AAD, Moghimi N, Jabbari B. Hyperhidrosis: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins. 2013;5:821–40.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Augustin M, Radtke MA, Herberger A, Kornek T, Heigel H, Schaefer I. Prevalence and disease burden of hyperhidrosis in the adult population. Dermatology. 2013;227:10–3.CrossRefPubMedGoogle Scholar
  9. 9.
    Rajagopal R, Mallya NB. Comparative evaluation of botulinum toxin vs iontophoresis with topical aluminum chloride hexahydrate in treatment of palmar hyperhidrosis. Med J Armed Forces India. 2014;70:247–52.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Purtuloglu T, Atim A, Deniz S, Kavakli K, Sapmaz E, Gurkok S, Kurt E, Turan A. Effect of radiofrequency ablation and comparison with surgical sympathectomy in palmar hyperhidrosis. Eur J Cardiothorac Surg. 2013;43(6):e151–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Joo S, Lee GD, Haam S, Lee S. Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: r4 sympathicotomy vs R4 sympathetic clipping versus R3 sympathetic clipping. J Thorac Dis. 2016;8(5):934–41.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zhang B, Li Z, Yang X, Li G, Wang Y, Cheng J, Tang X, Wang F. Anatomical variations of the upper thoracic sympathetic chain. Clin Anat. 2009;22(5):595–600.CrossRefPubMedGoogle Scholar
  13. 13.
    Romano M, Giojelli A, Mainenti PP, Tamburrini O, Salvatore M. Upper thoracic sympathetic chain neurolysis under CT guidance. A two year follow-up in patients with palmar and axillary hyperhidrosis. Radiol Med. 2002;104(5–6):421–5.PubMedGoogle Scholar
  14. 14.
    Hynes Cf, Seevaratham S, Gesuwan K, Margolis M, Marshall MB. The efficacy of oral anticholinergics for sympathetic overactivity in a thoracic surgery clinic. J Thorac Cardiovasc Surg. 2016. doi: 10.1016/j.jtcvs.2016.03.092. [Epub ahead of print].

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  1. 1.Vascular & Interventional RadiologyAmerican Medical CenterNicosiaCyprus
  2. 2.NeurosurgeryAmerican Medical CenterNicosiaCyprus
  3. 3.Vascular & Interventional RadiologyJohns Hopkins HospitalBaltimoreUSA

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