The Wall to Lumen Ratio of the Radial Artery in Patients with Raynaud’s Phenomenon

Abstract

The pathophysiology of Raynaud’s phenomenon (RP) remains an enigma. Whatever theories proposed, the final event leading to the clinical symptoms is the occlusion of digital vessels. However, the possibility that the upstream large arterial vessels contribute to vasopasm has never been investigated. We used a high resolution echo-tracking device to calculate lumen diameter, wall thickness, and circumferential wall stress upstream the digital arteries, i.e. at the site of the radial artery. Fifteen control women, 15 age-matched women with primary RP (PRP) and 15 women presenting with a secondary RP due to systemic sclerosis (SSc) were included in the study. All vasodilating agents were discontinued 72 h before the study session, which was conducted in a room with a stable ambient temperature of 22°C Radial artery internal diameter, intima-media wall thickness, and mean arterial pressure were measured simultaneously. Internal diameter of patients with RP was significantly decreased (p& < 0.001 vs. controls) whereas intima-media wall thickness and mean arterial pressure were closely similar in the three groups, resulting in an increase in the wall to lumen ratio. Thus, circumferential wall stress was significantly smaller (p& < 0.05 vs. controls) in patients with RP. In conclusion, this study demonstrates that in patients with RP, wall to lumen ratio is increased and circumferential wall stress is reduced at the level of the radial artery. It is suggested that the geometrical and mechanical changes of this artery may favor the downstream occlusive phenomena observed in patients with PRP and SSc.

Atherosclerosis in systemic sclerosis: A systematic review and meta-analysis

“…One study (25%) did find significantly higher rates of abnormal ABI amongst the SSc patients compared to healthy controls (17% vs. 0%) (10). Three studies evaluated asymptomatic atherosclerosis in specific vessels (renal(44), radial(45), and ulnar(46)), and 2 of the studies (67%) found that asymptomatic atherosclerosis was increased in SSc compared to controls(44, 46). Trostle et al found significantly increased intimal thickening in medium and large renal vessels of diffuse SSc patients without a history of renal crisis when compared to controls(44).…”

Arterial remodelling in Fabry disease

“…The inward remodelling of medium-sized arteries in Fabry disease may explain the higher carotid/radial PP ratio, through increased wave re ections. The decrease in circumferential wall stress, observed at the site of the radial artery, may favour the occurrence of downstream occlusive phenomena, such as those observed in Raynaud's syndrome (25).…”

Thrombotic complications after radial arterial line placement in systemic sclerosis: A case series

“…Digital stenosis or occlusions are most frequently found in the ulnar artery, 2 nd to 5 th proper palmar digital artery, and the superficial palmar arch [18]. While it is less frequently reported in the radial artery [19], one study demonstrated an increased wall to lumen ratio in scleroderma patients compared to controls using a high resolution echo-tracking device, and this suggested increased circumferential wall stress of the radial artery [20]. In this context, mechanical changes of the radial artery may favor downstream occlusive phenomena in patients with Raynaud’s phenomenon and scleroderma.…”