Severe Raynaud's phenomenon—A streamlined approach to acute management

Abstract

Raynaud's phenomenon is an exaggerated vasospastic response to cold or emotional stress which not only may cause the patient severe pain but also critical ischaemia and necrosis of the digits. We report the case of a 69-year-old woman who presented with rest pain, impending ulceration and necrosis of finger tips due to an episode of left-sided Raynaud's phenomenon. Intravenous prostacyclin was administered successfully as a bridge to endoscopic thoracic sympathectomy. Vascular surgery units are ideally positioned for the acute management of severe Raynaud's phenomenon to provide continuity of care to patients with profound digital ischaemia and impending tissue loss.

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

“…On exposure to cold, the distal finger pads initially become pale as a result of vasoconstriction, then cyanosis occurs, secondary to tissue hypoxia, and finally they turn red, as tissue reperfusion occurs [1]. 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].…”