Management of Raynauds Phenomenon

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Management ofRaynauds Phenomenon

• Eyal Kimchi
• Vascular Surgery
• 2008.05.29

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Raynauds Phenomenon
Cold Stress
Vasospasm Ischemia
Stasis Deoxygenation
Reperfusion Hyperemia
images from MedlinePlus / NIH
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Triggered vasospasm
from Oxford Textbook of Surgery
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Etiology

• Primary
• Symmetrical
• Young
• Female
• Family history

Secondary Autoimmune Scleroderma Lupus Vasospa
sm Migraine Prinzmetal angina Occlusive Athero
sclerosis Thrombangitis obilterans
from Raynauds phenomenon A proposal for
classificaction (1992)
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Key Studies
Nailfold capilloroscopy ( Digital flow)
Anti Nuclear Antibodies ( ESR)
Normal
Dilated
Avascular
via UpToDate
from Resource Materials in Rheumatology
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Symptoms and Signs

• Pain
• Paresthesia
• Paralysis

Ulceration Gangrene
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Progression
Ischemia
Necrosis
Fibrosis
Inflammation
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Interventions Lifestyle

• Avoidance of
• Cold
• Stress
• Smoking
• Sympathomimetics
• Vibrating tools
• Placebo effects

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Interventions Medical

• Calcium channel blockers (nifedipine)
• Anti-?2 adrenergic
• Vasodilators (nitrates)
• Serotonin
• Phosphodiesterase inhibitors
• Endothelin antagonist (bosentan)
• Anticoagulation

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Interventions Prostaglandins
Vasodilation, inhibition of platelet aggregation
from hopkinsmedicine.org / Neurodegeneration lab
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Interventions Prostaglandins
from YNHH Formulary, Micromedex
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Interventions Sympathectomy

• Technique
• Open
• Endoscopic
• Anesthetic

• Location
• Cervicothoracic
• Lumbar
• Digital

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Sympathectomy Local anesthetic
Greengrass et al. (2003) Regional Anesthesia and
Pain Medicine
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Sympathectomy Lumbar
Post-op course Neuralgia (12) Amputation (15)
Postelthwaite (1973) Brit J Surg
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Sympathectomy Local surgical
Balogh et al. (2002) Journal of Hand Surgery
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Sympathectomy Local surgical
Greengrass et al. (2003) Regional Anesthesia and
Pain Medicine
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Sympathectomy Local surgical
Sympathectomy distal to wrist, resection of nerve
of Henle Post 1 year follow up, subjective vs.
objective diagnostic evidence
Balogh et al. (2002) Journal of Hand Surgery
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