Surgical management for refractory Raynaud's phenomena, a rare presentation of upper extremity limb ischemia

Abstract

Raynaud's is an often-underdiagnosed vascular disorder. Primary Raynaud's (Raynaud's disease) is a result of vasospasm in the absence of underlying disorder, while Raynaud's phenomenon (RP) occurs secondary to an autoimmune process. Raynaud's disease and RP rarely present with gangrenous changes to the digits of the hand. Standard treatment of RP involves lifestyle modification and various medication regimens. There is a paucity of literature for the surgical treatment of RP. This case series appears to be the first in the literature to utilize open surgery as treatment when medical management fails to prevent digital ischemia and gangrene. In the Raynaud's patient that presents with the sequelae of severe ischemia and gangrene, additional imaging such as noninvasive studies and angiography should be considered, as physical exam alone may be misleading. When diagnostic imaging demonstrates occlusive disease secondary to the progression of vasculitis, surgical management has potential for therapeutic benefit. We present two cases of open surgical bypass as an adjunctive treatment for limb salvage in the patients with RP. Patient consent was obtained for details of the case series to be used for publication. This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.