Surgical Strategies in the Management of Raynaud's Phenomenon: Comparative Analysis of Trends and Effectiveness Incorporating New Clinical Data

Authors

  • Aleksandra Cygnarowicz Bonifraters Medical Center sp. z o. o. Branch in Krakow, Trynitarska 11 St., 31-061 Krakow, Poland https://orcid.org/0009-0002-2208-0104
  • Mariola Turemka Voivodeship Hospital in Bialystok Marii Skladowskiej-Curie 26 St., 15-278 Bialystok, Poland https://orcid.org/0009-0001-8219-6515
  • Negar Hosseinnejad The 5 Military Clinical Hospital with Polyclinic SPZOZ in Cracow, Wroclawska Street 1/3, 30-901 Cracow, Poland https://orcid.org/0009-0002-3552-9513
  • Karolina Sacher Silesian Center for Heart Diseases Zabrze, Marii Skłodowskiej-Curie 9 St., Zabrze, Poland https://orcid.org/0009-0001-8875-5912
  • Aneta Klaudia Wojtas Municipal Hospital in Siemianowice Śląskie sp. z o.o., 1. Maja 9 St., 41-100 Siemianowice Śląskie, Poland https://orcid.org/0009-0002-6072-1232
  • Krystyna Zabojska Hospital of Our Lady of Perpetual Help in Wolomin, Gdynska 1/3, 05-200 Wolomin, Poland https://orcid.org/0009-0002-6962-0497
  • Mikołaj Biskupski Department of Interventional Cardiology and Cardiac Arrhythmias, Teaching Hospital No. 2 of the Medical University of Lodz, Zeromskiego Street 113 90-549 Lodz, Poland https://orcid.org/0009-0009-8103-4053
  • Urszula Korotko The Provincial Specialist Hospital in Ciechanów, Powstańców Wielkopolskich 2 St., 06-400 Ciechanów, Poland https://orcid.org/0009-0004-9226-6451
  • Kinga Witowska The 5 Military Clinical Hospital with Polyclinic SPZOZ in Cracow, Wroclawska Street 1/3, 30-901 Cracow, Poland https://orcid.org/0009-0003-2389-4887
  • Aneta Mandziuk Independent Public Health Care Facility of the Ministry of Interior and Administration in Białystok/ Fabryczna Street 27 15-471 Białystok, Poland https://orcid.org/0009-0001-2787-9479

DOI:

https://doi.org/10.12775/JEHS.2024.76.56561

Keywords

raynaud's phenomenon, sympathectomy, arterial bypass, venous arterialization

Abstract

Introduction and objective

Raynaud's phenomenon is a condition of unknown origin and complex pathophysiology, characterized by an excessive sensitivity to vasoconstriction of arteries in the hands, feet, auricles and nose, leading to a characteristic constellation of symptoms with at least two phase course: pallor and cyanosis. The aim of this work is to review surgical techniques for treating patients with Raynaud's phenomenon and to attempt to determine whether the results of current studies may support earlier initiation of surgical treatment.

Review methods

To prepare this review, the authors used PubMed and Google Scholar databases, searching the following keywords: "Raynaud's phenomenon", "Raynaud's phenomenon surgical management", "digital artery reconstruction" "sympathectomy", "arterial bypass", "venous arterialization". The search results were limited to studies in English from 2006 to 2024, as well as key studies from earlier years.

Brief description of the state of knowledge

Currently, patients who are qualified for surgical treatment in the course of Raynaud's phenomenon are those who have symptoms or non-healing ulceration despite of an appropriate pharmacological treatment. Current therapy using calcium channel blockers does not bring full satisfaction to patients. Therefore, the search for optimal therapy continues, with a particular focus on the development of microsurgical treatment techniques.

Summary

The occurrence of Raynaud's phenomenon, especially the pain and discomfort associated with it, significantly reduces patients' quality of life. Due to advances in the field of microsurgery and the discovery of new mechanisms responsible for the development of Raynaud's phenomenon, earlier patient qualification for surgical procedures is becoming possible. This gives hope for further development of surgical approaches and improvements in treatment outcomes.

Keywords: Raynaud's phenomenon; sympathectomy; arterial bypass; venous arterialization

References

[1] Pauling JD, Saketkoo LA, Matucci-Cerinic M, Ingegnoli F, Khanna D. The patient experience of Raynaud's phenomenon in systemic sclerosis. Rheumatology (Oxford). 2019 Jan 1;58(1):18-26. doi: 10.1093/rheumatology/key026. PMID: 29538754; PMCID: PMC6293480.

[2] De Angelis R, Salaffi F, Grassi W. Health-related quality of life in primary Raynaud phenomenon. J Clin Rheumatol. 2008 Aug;14(4):206-10. doi: 10.1097/RHU.0b013e31817a2485. PMID: 18766120.

[3] Wigley FM, Flavahan NA. Raynaud's Phenomenon. N Engl J Med. 2016 Aug 11;375(6):556-65. doi: 10.1056/NEJMra1507638. PMID: 27509103.

[4] Flavahan NA. A vascular mechanistic approach to understanding Raynaud phenomenon. Nat Rev Rheumatol. 2015 Mar;11(3):146-58. doi: 10.1038/nrrheum.2014.195. Epub 2014 Dec 23. PMID: 25536485.

[5] Coffman JD, Cohen AS. Total and capillary fingertip blood flow in Raynaud's phenomenon. N Engl J Med. 1971 Jul 29;285(5):259-63. doi: 10.1056/NEJM197107292850505. PMID: 5090397.

[6] Kahaleh, B. and Matucci Cerinic, M. (1995), Raynaud's phenomenon and scleroderma dysregulated neuroendothelial control of vascular tone. Arthritis & Rheumatism, 38: 1-4. https://doi.org/10.1002/art.1780380102

[7] Matucci-Cerinic M, Kahaleh B, Wigley FM. Review: evidence that systemic sclerosis is a vascular disease. Arthritis Rheum. 2013 Aug;65(8):1953-62. doi: 10.1002/art.37988. PMID: 23666787

[8] Garner R, Kumari R, Lanyon P, et al. Prevalence, risk factors and associations of primary Raynaud’s phenomenon: systematic review and meta-analysis of observational studies. BMJ Open 2015;5:e006389. doi:10.1136/bmjopen-2014- 006389

[9] Guiducci S, Matucci-Cerinic M. Definition, nomenclature, and diagnostic criteria. In: Wigley FM, Herrick AL, Flavahan NA, eds. Raynaud’s phenomenon: a guide to pathogenesis and treatment. New York: Springer, 2015:13-20.

[10] Ture HY, Lee NY, Kim NR, Nam EJ. Raynaud's Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment. Vasc Specialist Int. 2024 Jul 23;40:26. doi: 10.5758/vsi.240047. PMID: 39040029; PMCID: PMC11266082.

[11] Freedman RR, Ianni P. Role of cold and emotional stress in Raynaud's disease and scleroderma. Br Med J (Clin Res Ed). 1983 Nov 19;287(6404):1499-502. doi: 10.1136/bmj.287.6404.1499. PMID: 6416474; PMCID: PMC1549944

[12] Hughes M, Snapir A, Wilkinson J, Snapir D, Wigley FM, Herrick AL. Prediction and impact of attacks of Raynaud's phenomenon, as judged by patient perception. Rheumatology (Oxford). 2015 Aug;54(8):1443-7. doi: 10.1093/rheumatology/kev002. Epub 2015 Mar 9. PMID: 25752312.

[13] Di Donato S, Huang S, Pauling JD, Del Galdo F, Sabbagh M, Khanna D, Hughes M. Clinically relevant differences between primary Raynaud's phenomenon and secondary to connective tissue disease. Semin Arthritis Rheum. 2024 Oct;68:152521. doi: 10.1016/j.semarthrit.2024.152521. Epub 2024 Jul 18. PMID: 39089171.

[14] Maverakis E, Patel F, Kronenberg DG, Chung L, Fiorentino D, Allanore Y, Guiducci S, Hesselstrand R, Hummers LK, Duong C, Kahaleh B, Macgregor A, Matucci-Cerinic M, Wollheim FA, Mayes MD, Gershwin ME. International consensus criteria for the diagnosis of Raynaud's phenomenon. J Autoimmun. 2014 Feb-Mar;48-49:60-5. doi: 10.1016/j.jaut.2014.01.020. Epub 2014 Feb 1. PMID: 24491823; PMCID: PMC4018202.

[15] Hysa E, Pizzorni C, Sammorì S, et al. Microvascular damage in autoimmune connective tissue diseases: a capillaroscopic analysis from 20 years of experience in a EULAR training and research referral centre for imaging. RMD Open 2023;9:e003071. doi:10.1136/ rmdopen-2023-003071

[16] Ha T, Oh H, Kim J. Technetium-99m hand perfusion scintigraphy (Raynaud's scan) as a method of verification in hand arm vibration syndrome: a review. Ann Occup Environ Med. 2022 Oct 11;34:e26. doi: 10.35371/aoem.2022.34.e26. PMID: 36452251; PMCID: PMC9685291.

[17] Herrick AL, Murray A. The role of capillaroscopy and thermography in the assessment and management of Raynaud's phenomenon. Autoimmun Rev. 2018 May;17(5):465-472. doi: 10.1016/j.autrev.2017.11.036. Epub 2018 Mar 9. PMID: 29526628.

[18] Herrick AL, Dinsdale G, Murray A. New perspectives in the imaging of Raynaud's phenomenon. Eur J Rheumatol. 2020 Oct;7(Suppl 3):S212-S221. doi: 10.5152/eurjrheum.2020.19124. Epub 2020 Jul 6. PMID: 33164735; PMCID: PMC7647685.

[19] Murray AK, Moore TL, Manning JB, Taylor C, Griffiths CE, Herrick AL. Noninvasive imaging techniques in the assessment of scleroderma spectrum disorders. Arthritis Rheum. 2009 Aug 15;61(8):1103-11. doi: 10.1002/art.24645. PMID: 19644893.

[20] Connell DA, Koulouris G, Thorn DA, Potter HG. Contrast-enhanced MR angiography of the hand. Radiographics. 2002 May-Jun;22(3):583-99. doi: 10.1148/radiographics.22.3.g02ma16583. PMID: 12006689.

[21] Cinà CS, Cinà MM, Clase CM. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results. J Minim Access Surg. 2007 Oct;3(4):132-40. doi: 10.4103/0972-9941.38907. PMID: 19789674; PMCID: PMC2749196.

[22] Thune TH, Ladegaard L, Licht PB. Thoracoscopic sympathectomy for Raynaud's phenomenon--a long term follow-up study. Eur J Vasc Endovasc Surg. 2006 Aug;32(2):198-202. doi: 10.1016/j.ejvs.2006.01.017. Epub 2006 Mar 27. PMID: 16564187.

[23] Van Roon, A. M., Kuijpers, M., van de Zande, S. C., Abdulle, A. E., van Roon, A. M., Bos, R., Mulder, D. J. (2019). Treatment of resistant Raynaud’s phenomenon with single-port thoracoscopic sympathicotomy: a novel minimally invasive endoscopic technique. Rheumatology. doi:10.1093/rheumatology/kez386

[24] Karapolat, S., Turkyilmaz, A., & Tekinbas, C. (2018). Effects of Endoscopic Thoracic Sympathectomy on Raynaud’s Disease. Journal of Laparoendoscopic & Advanced Surgical Techniques, 28(6), 726–729. doi:10.1089/lap.2017.0634

[25] Morgan RF, Reisman NR, Wilgis EF. Anatomic localization of sympathetic nerves in the hand. J Hand Surg Am. 1983 May;8(3):283-8. doi: 10.1016/s0363-5023(83)80161-0. PMID: 6875230.

[26] Merritt, W. H. (2015). Role and Rationale for Extended Periarterial Sympathectomy in the Management of Severe Raynaud Syndrome. Hand Clinics, 31(1), 101–120. doi:10.1016/j.hcl.2014.09.011

[27] Hartzell TL, Makhni EC, Sampson C. Long-term results of periarterial sympathectomy. J Hand Surg Am. 2009 Oct;34(8):1454-60. doi: 10.1016/j.jhsa.2009.05.003. Epub 2009 Aug 15. PMID: 19683883.

[28] Ruch, D. S., Holden, M., Smith, B. P., Smith, T. L., & Koman, L. A. (2002). Periarterial sympathectomy in scleroderma patients: Intermediate-term follow-up. The Journal of Hand Surgery, 27(2), 258–264. doi:10.1053/jhsu.2002.29483

[29] O’BRIEN, Bm., KUMAR, P. A. V., MELLOW, C. G., & OLIVER, T. V. (1992). Radical Microarteriolysis in the Treatment of Vasospastic Disorders of the Hand, Especially Scleroderma. Journal of Hand Surgery, 17(4), 447–452. doi:10.1016/s0266-7681(05)80272-4

[30] Cereceda-Monteoliva N, Smart YW, Ojelade E, Schaller G, Berber O. Distal periarterial sympathectomy surgery for chronic digital ischemia: A systematic review of the literature. J Orthop. 2023 Dec 6;50:76-83. doi: 10.1016/j.jor.2023.11.072. PMID: 38179435; PMCID: PMC10762319.

[31] Pace, C. S., & Merritt, W. H. (2017). Extended Periarterial Sympathectomy: Evaluation of Long-term Outcomes. HAND, 13(4), 395–402. doi:10.1177/1558944717715119

[32] Momeni, A., Sorice, S. C., Valenzuela, A., Fiorentino, D. F., Chung, L., & Chang, J. (2015). Surgical treatment of systemic sclerosis-is it justified to offer peripheral sympathectomy earlier in the disease process? Microsurgery, 35(6), 441–446. doi:10.1002/micr.22379

[33] Yu, F., Liu, Y., Zhang, C. et al. Efficacy analysis of minimally invasive surgery for Raynaud’s syndrome. BMC Surg 23, 313 (2023). https://doi.org/10.1186/s12893-023-02225-x

[34] Jacob S, Nassef A, Belli AM, Dormandy JA, Taylor RS. Vascular surgical society of great britain and ireland: distal venous arterialization for non-reconstructable arterial disease. Br J Surg. 1999 May;86(5):694. doi: 10.1046/j.1365-2168.1999.0694a.x. PMID: 10361200.

[35] Chloros GD, Li Z, Koman LA. Long-term successful outcome of severe hand ischemia using arterialization with reversal of venous flow: case report. J Hand Surg Am. 2008 Sep;33(7):1048-51. doi: 10.1016/j.jhsa.2008.02.026. PMID: 18762095.

[36] Kind GM. Arterialization of the venous system of the hand. Plast Reconstr Surg. 2006 Aug;118(2):421-8. doi: 10.1097/01.prs.0000227671.29771.c3. PMID: 16874213

[37] Zeng W, Hammert WC. Arterialization of the Venous System for Treatment of Chronic Ischemia in the Hand. Plast Reconstr Surg. 2016 Apr;137(4):1213-1220. doi: 10.1097/PRS.0000000000002007. PMID: 27018676.

[38] Thibaudeau, Stephanie M.D.; Serebrakian, Arman T. M.S.; Gerety, Patrick A. M.D.; Levin, L. Scott M.D.. An Algorithmic Approach to the Surgical Treatment of Chronic Ischemia of the Hand: A Systematic Review of the Literature. Plastic and Reconstructive Surgery 137(5):p 818e-828e, May 2016. | DOI: 10.1097/PRS.0000000000002044

[39] Matarrese MR, Hammert WC. Revascularization of the ischemic hand with arterialization of the venous system. J Hand Surg Am. 2011 Dec;36(12):2047-51. doi: 10.1016/j.jhsa.2011.09.022. Epub 2011 Nov 4. PMID: 22054709.

[40] Peters BR, Liu T, Buchel E, Sigurdson L, Hayakawa T, Islur A. Arterialization of the Venous System for Acute and Chronic Ischemia of the Hand: A Case Series With Prospective Duplex Ultrasound Assessment. Hand (N Y). 2020 Mar;15(2):170-176. doi: 10.1177/1558944718810873. Epub 2018 Nov 12. PMID: 30417686; PMCID: PMC7076621.

[41] Colen DL, Ben-Amotz O, Stephanie T, Serebrakian A, Carney MJ, Gerety PA, Levin LS. Surgical Treatment of Chronic Hand Ischemia: A Systematic Review and Case Series. J Hand Surg Asian Pac Vol. 2019 Sep;24(3):359-370. doi: 10.1142/S2424835519500462. PMID: 31438795.

[42] Yoshida S, Imai H, Roh S, Mese T, Koshima I. Simultaneous bilateral distal venous arterialization between redial artery and cephalic vein in dorsal hand for Raynaud's phenomenon in both hands: A case report. Microsurgery. 2023 May;43(4):397-402. doi: 10.1002/micr.31014. Epub 2023 Jan 29. PMID: 36710439.

[43] Jones NF, Emerson ET. Interposition vein graft configurations for microsurgical revascularization of the ischemic hand. Tech Hand Up Extrem Surg. 1999 Jun;3(2):121-30. doi: 10.1097/00130911-199906000-00009. PMID: 16609446.

[44] Miller TJ, Lin WC, Safa B. Radial Artery Occlusion in a Patient With Lupus, Antiphospholipid Syndrome, and Raynaud Phenomenon: A Multimodal Approach. J Hand Surg Am. 2020 Jul;45(7):664.e1-664.e5. doi: 10.1016/j.jhsa.2019.08.009. Epub 2019 Oct 2. PMID: 31585746.

[45] Frontario, S. Christopher et al. Surgical Management for Refractory Raynaud’s Phenomena: A Rare Presentation of Upper Extremity Limb Ischemia Journal of Vascular Surgery, Volume 75, Issue 6, e273 - e274 https://doi.org/10.1016/j.avsurg.2022.100078

[46] Kwon ST, Eun SC, Baek RM, Minn KW. Peripheral arterial- bypass grafts in the hand or foot in systemic sclerosis. J Plast Reconstr Aesthet Surg. 2009 Jul;62(7):e216-21. doi: 10.1016/j.bjps.2008.11.080. Epub 2009 Feb 13. PMID: 19217840.

[47] Cornejo A, Neaman KC, Srinivasan RC, Mithani SK, Pederson WC. In Situ Venous Bypass for Chronic Hand Ischemia: A Review of 25 Cases in 23 Patients. Ann Plast Surg. 2016 Jun;76 Suppl 4:S275-9. doi: 10.1097/SAP.0000000000000761. PMID: 27187250.

[48] Fox P, Chung L, Chang J. Management of the hand in systemic sclerosis. J Hand Surg Am. 2013 May;38(5):1012-6; quiz 1017. doi: 10.1016/j.jhsa.2013.02.012. Epub 2013 Apr 3. PMID: 23561724.

[49] Tomaino MM. Digital arterial occlusion in scleroderma: is there a role for digital arterial reconstruction? J Hand Surg Br. 2000 Dec;25(6):611-3. doi: 10.1054/jhsb.2000.0439. PMID: 11106531.

[50] Park SO, Wang HW, Han Y, Ahn HC. Digital artery reconstruction with interposition vein graft: impact on secondary Raynaud's phenomenon. Rheumatology (Oxford). 2024 Aug 1;63(8):2123-2127. doi: 10.1093/rheumatology/kead524. PMID: 37758266.

[51] Granel B, Daumas A, Jouve E, Harlé JR, Nguyen PS, Chabannon C, Colavolpe N, Reynier JC, Truillet R, Mallet S, Baiada A, Casanova D, Giraudo L, Arnaud L, Veran J, Sabatier F, Magalon G. Safety, tolerability and potential efficacy of injection of autologous adipose-derived stromal vascular fraction in the fingers of patients with systemic sclerosis: an open-label phase I trial. Ann Rheum Dis. 2015 Dec;74(12):2175-82. doi: 10.1136/annrheumdis-2014-205681. Epub 2014 Aug 11. PMID: 25114060; PMCID: PMC4680117.

[52] Bank J, Fuller SM, Henry GI, Zachary LS. Fat grafting to the hand in patients with Raynaud phenomenon: a novel therapeutic modality. Plast Reconstr Surg. 2014 May;133(5):1109-1118. doi: 10.1097/PRS.0000000000000104. PMID: 24445877.

Downloads

Published

2024-12-20

How to Cite

1.
CYGNAROWICZ, Aleksandra, TUREMKA, Mariola, HOSSEINNEJAD, Negar, SACHER, Karolina, WOJTAS, Aneta Klaudia, ZABOJSKA, Krystyna, BISKUPSKI, Mikołaj, KOROTKO, Urszula, WITOWSKA, Kinga and MANDZIUK, Aneta. Surgical Strategies in the Management of Raynaud’s Phenomenon: Comparative Analysis of Trends and Effectiveness Incorporating New Clinical Data. Journal of Education, Health and Sport. Online. 20 December 2024. Vol. 76, p. 56561. [Accessed 27 January 2025]. DOI 10.12775/JEHS.2024.76.56561.

Issue

Vol. 76 (2024)

Section

Medical Sciences

License

Copyright (c) 2024 Aleksandra Cygnarowicz, Mariola Turemka, Negar Hosseinnejad, Karolina Sacher, Aneta Klaudia Wojtas, Krystyna Zabojska, Mikołaj Biskupski, Urszula Korotko, Kinga Witowska, Aneta Mandziuk

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0

Stats

Number of views and downloads: 101
Number of citations: 0