Peripheral arterial- bypass grafts in the hand or foot in systemic sclerosis

Surgical treatment of systemic sclerosis—is it justified to offer peripheral sympathectomy earlier in the disease process?

“…The difficulty in assessing the efficacy of peripheral sympathectomy in patients with SSc is multifactorial, including previous studies with a small number of patients, a rather heterogeneous or poorly characterized patient population, as well as variability with respect to the surgical technique employed . Differences exist with respect to the vessels addressed (e.g., sympathectomy limited to the common and proper digital vessels vs. adventitial stripping of the radial and ulnar artery in addition to the palmar arch and digital vessels with or without bypass grafting) as well as the length of the vascular segment dissected . Furthermore, outcome measures are not standardized.…”

“…8,15,16,18,21 Differences exist with respect to the vessels addressed (e.g., sympathectomy limited to the common and proper digital vessels vs. adventitial stripping of the radial and ulnar artery in addition to the palmar arch and digital vessels with or without bypass grafting) as well as the length of the vascular segment dissected. 8,14,19,[22][23][24] Furthermore, outcome measures are not standardized. While some authors choose reduction in the number of targeted ulcers, 8 others choose pain relief, improvement in digital blood flow, or difference in postoperative digital temperature as an outcome measure.…”

Kritische Extremitätenischämie bei systemischer Sklerose

“…Handchirurgen eine Option sein, sofern größere Gefäße betroffen sind [12]. So kann eine Gefäßrekonstruktion die Blutversorgung wiederherstellen und das RaynaudPhänomen, Schmerzen, digitale Ulzerationen und Ischämie positiv beein flussen [31,42]. Auch eine digitale Sym pathektomie hat in Einzelfällen gute Resul tate erzielt [29].…”

Raynaud’s phenomenon and digital ischemia: a practical approach to risk stratification, diagnosis and management

“…Park and colleagues recently studied a cohort of 19 scleroderma patients and recommended that patients with scleroderma associated with digital ulcers or severe Raynaud’s should consider angiography with ulnar revascularization if indicated because of the increased risk of digital loss with macrovascular disease [47, 56]. Angiography is also used to confirm the site of vascular occlusion prior to peripheral artery bypass grafts in the hands and feet of two patients with severe Raynaud’s [57]. The clinical application of angiography continues to grow, and based on the available data we recommend using this application to define the vascular anatomy of patients with severe digital ischemia who are candidates for angioplasty or surgery.…”