Cervical sympathectomy is no longer recommended because observational studies showed that it was not effective in the long term and that side effects were intolerable-patients often needed digital amputation. A therapeutic study with grade III evidence study found that digital artery (palmar) sympathectomy can lead to complete healing and a decrease in the number of ulcers although it is a highly specialised procedure and this benefit is not seen for chronic digital ischaemia. Decompression arteriolysis and arterial reconstruction can be performed at the same time.