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

Wigley, Fredrick M.

doi:10.2217/ijr.10.17

Cited by 40 publications

(30 citation statements)

References 114 publications

(113 reference statements)

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“…The warm climate could be argued to be a factor. 3 The other causes of transient digital ischaemia such as Primary Raynauds disease, were not included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The upper limb vasculature seems also to be more sensitive to triggers such as cold and emotion 3 and is followed by a vasospasm induced by sympathetic over activity 3 . Exposure to cold aggravates many aetiological mechanisms.…”

Section: Figure 1: Common Sources and Sites Of Occlusionmentioning

confidence: 99%

“…Exposure to cold aggravates many aetiological mechanisms. They are changes associated with viscosity, the activity of the vascular endothelium, and local neural reflexes 3 .Smoking too aggravates digital ischaemia 3,4 .…”

Section: Figure 1: Common Sources and Sites Of Occlusionmentioning

confidence: 99%

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Patterns of chronic ischaemia of the upper limbs in the central province of Sri Lanka

et al. 2018

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“…The warm climate could be argued to be a factor. 3 The other causes of transient digital ischaemia such as Primary Raynauds disease, were not included in our study.…”

Section: Discussionmentioning

confidence: 99%

Section: Figure 1: Common Sources and Sites Of Occlusionmentioning

confidence: 99%

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Patterns of chronic ischaemia of the upper limbs in the central province of Sri Lanka

et al. 2018

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“…RP has been classified clinically into two types: primary RP, which is mostly benign; and secondary RP, which in 10–20% of cases is associated with an underlying systemic disease [such as Sjören’s syndrome, systemic sclerosis, CREST syndrome (calcinosis, RP, esophageal dysmotility, sclerodactyly, and telangiectasia), systemic lupus erythematosus, or dermatomyositis], or with drugs or extrinsic vascular obstruction [7]. Primary RP is characterized by symmetrical attacks on the digits in the absence of peripheral vascular disease, tissues necrosis, ulceration, or gangrene [2, 8]. Meanwhile, the attacks of secondary RP are associated with more severe asymmetric affection with tissue necrosis, ulceration, and gangrene [2, 8].…”

Section: Discussionmentioning

confidence: 99%

Difficulties in diagnosis and treatment of severe secondary Raynaud’s phenomenon in a Cameroonian woman: a case report

Agbor¹,

Njim

Aminde

2016

J Med Case Reports

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BackgroundRaynaud’s phenomenon is a microvascular disorder that results in exaggerated vasoconstriction over vasodilatation secondary to an alteration in autonomic control. Though benign, it can result in severe ulceration and ultimately gangrene associated with disfiguration and permanent deformity. We present a case of severe secondary Raynaud’s phenomenon in a black-African patient from a resource-limited setting, with focus on the difficulties encountered in the diagnosis and treatment.Case presentationA 43-year-old female Cameroonian farmer with a 7-year history of episodic paresthesia in her fingers and toes (when exposed to cold) presented to our emergency department with severe pain, ulceration, and “darkening” of her fingertips over a period of 2 days. An examination revealed bilateral ulceration and dry gangrene of her fingers and toes, based on which a diagnosis of secondary Raynaud’s phenomenon due to a connective tissue disease was proposed. Results of paraclinical investigations were normal. Lifestyle modification along with a calcium channel blocker and phosphodiesterase type 5 inhibitor provided significant relief.ConclusionsAn early diagnosis and knowledge on appropriate treatment of Raynaud’s phenomenon is of vital importance to prevent permanent tissue damage and disability. Relying on biphasic color change for the diagnosis of Raynaud’s phenomenon in black Africans can be potentially misleading.

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“…heparin and in case of vascular occlusion systemic i.v. recombinant tissue plasminogen activator (rtpa) are firstline approach [2,6,7]. Surgical treatment of limb injuries consists of digital sympathectomy, arterial reconstruction and amputation [8].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Remote Ischaemic Conditioning in Critical Ischemia of the Digitals of Upper and Lower Limbs

Schahab¹,

Aksoy²,

Schahab³

et al. 2017

Vasc Med Surg

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Aim: The aim of our study was to determine the effectiveness and safety of remote ischaemic conditioning (RIC) in combination with i.v. prostavasin as a method of treatment for patients with peripheral acral vasculopathy, presenting as critical ischemia of the digitals of upper and lower limbs at the time of presentation with either surgical nor interventional treatment option Method: 33 patients were included in this non-randomized, prospective pilot-study with compassionate use. Primary endpoints were healing of ulcerations and amputation free time, secondary endpoint was safety of RIC.For the RIC, a blood flow reduction in the extremities was held in 2 cycles for over 5 minutes (20 mmHg over the systolic blood pressure) with 5 minutes reperfusion. During this time the medical agents were infused through a superficial vein into index extremity transvenously. The medication included: 2500 i.e., Heparin bolus, 5 µg PGE-1 in a 50 mL syringe with an isotonic solution. In cases where a vascular occlusion was seen in angiography additionally to PGE-1, 20 mg rt-PA was infused. Results:In 33 cases, transcutaneous oxygen partial pressure (TcPO 2 ) levels increased significantly from 33 ± 16 mmHg to 48 ± 13 mmHg (p=0.0005) after the therapy compared to baseline. In 33 cases there was an improvement from 55 ± 27 mmHg to 73 ± 27 mmHg (p ≤ 0.004) in the acral arterial pressure measurement. 31 patients showed significantly better perfusion and vascularisation of the ischemic extremity after the therapy demonstrated in acral oscillography (31/94%) and angiography (6/18%). In 16 cases ulcerations (n=20) healed after 15 sessions of RIC. There was no need of any major or minor amputation in all patients. Conclusion:The presented RIC therapy proved to be an effective and safe treatment in addition to best medical treatment for patients with acute acral vascular disorder, especially in acute digital ischaemia, without a surgical or an interventional option.

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

Cited by 40 publications

References 114 publications

Patterns of chronic ischaemia of the upper limbs in the central province of Sri Lanka

Patterns of chronic ischaemia of the upper limbs in the central province of Sri Lanka

Difficulties in diagnosis and treatment of severe secondary Raynaud’s phenomenon in a Cameroonian woman: a case report

Effectiveness of Remote Ischaemic Conditioning in Critical Ischemia of the Digitals of Upper and Lower Limbs

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