Endovascular Revascularization in Secondary Raynaud's Phenomenon

Endovascular intervention is not previously described in patients with exacerbated Raynaud ’ s phenomenon (RP). A 45-year-old male with secondary RP and CREST (Calcinosis cutis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasia) with a smoking history, who was noncompliant in the non-interventional treatment, presented with necrosis of the right hand in exacerbated RP. An intra-arterial digital subtraction angiography (DSA) showed occlusion of the right distal ulnar and radial arteries. Initial pharmacological therapy showed no improvement. Thrombolysis with Urokinase therapy had a beneficial, but not optimal, effect on perfusion. This was probably due to an atherosclerotic component. An endovascular intervention, 2 mm balloon dilatation, in the right radial artery; improved this significantly. The clinical situation proved stable and no expansion of necrosis was seen. An endovascular procedure, not previously described in RP management, can be helpful in the treatment of exacerbated RP; especially when an atherosclerotic component is present. doi: http://dx.doi.org/10.4021/jmc478 w