Background: The sympathetic nervous system (SNS) regulates vasomotor activity, piloerection, and sweating.  So, thoracoscopic sympathectomy can be utilized to treat upper extremity vascular insufficiency caused by artery blockage when revascularization is not an option due to the obstructions' distant placement. Objective: The study aimed to evaluate the results of revascularization after thoracoscopic sympathectomy in distal upper limb ischemia due to peripheral lesions. Patients and methods: This is a randomized retrospective study was done in Khamis Musheit General Hospital. The sample included 30 patients with upper extremity distal ischemia, operated in the period from February 2023 to December 2024. Results: The average follow-up period was eight months, with a range of one to twelve months.  Following the procedure, every patient showed apparent clinical improvement: 12 patients had their ulcers and trophic lesions completely heal, and 5 patients had their lesions improved and the necrotic regions clearly defined.  The majority of our patients showed pain improvement. Conclusion: Thoracoscopic sympathectomy helped for maximal limb saving and effective symptom management in patients with severe distal ischemia of the upper limb extremities. The operation should be taken into consideration earlier in the therapeutic choices since it is safe, minimally invasive, with a low risk of complications.