We treated in 2001 in our clinic two patients with upper limb ischemic disease. Both patients had chronic pain and cyanosis of the fingers, with trophic disorders and partial amputations of distal phalanges. They were previously submitted to medical treatment with no result. We present the technique used, resectional thoracoscopic sympathectomy including T2 and T3 ganglia. First of the patients was operated on bilaterally in two successive operations, the second one only on the right side. There was an uneventful postoperative evolution with good immediate and short term results.