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Ulnar artery involvement in systemic sclerosis (scleroderma).

Marian H Taylor1, John A McFadden, Marcy B Bolster

  • 1Department of Medicine, Medical University of South Carolina, Charleston 29425, USA.

The Journal of Rheumatology
|February 5, 2002
PubMed
Summary
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Systemic sclerosis patients with severe Raynaud's phenomenon and digital ulcers may benefit from screening for ulnar artery occlusion. Revascularization of the ulnar artery can significantly improve digital ulcer healing in these patients.

Area of Science:

  • Rheumatology
  • Vascular Surgery
  • Dermatology

Background:

  • Systemic sclerosis (SSc) commonly involves microvascular disease, but macrovascular complications like ulnar artery occlusion can occur.
  • Severe Raynaud's phenomenon (RP) with refractory digital ulcerations is a debilitating complication in SSc patients.
  • The role of large artery involvement, specifically ulnar artery occlusion, in the development of digital ulcers in SSc is not fully understood.

Purpose of the Study:

  • To investigate the association between ulnar artery occlusion and refractory digital ulcerations in patients with SSc.
  • To evaluate the effectiveness of screening for and revascularization of ulnar artery occlusive disease in improving digital ulcer healing.

Main Methods:

  • Retrospective chart review of 15 SSc patients with severe RP, digital ulceration, positive Allen test, and documented ulnar artery occlusive disease via angiography.

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  • Assessment of treatment outcomes including conventional medical therapy, stellate ganglion block, digital sympathectomy, and ulnar artery revascularization.

    • Main Results:

    • All 15 patients had SSc with severe RP and digital ulceration, failing conventional therapy.
    • Ulnar artery revascularization combined with digital sympathectomy in 8 patients led to dramatic improvement in RP and digital ulcer healing.
    • Conventional therapies and other interventions showed limited success in improving digital ulceration.

    Conclusions:

    • Routine screening with the Allen test is recommended for SSc patients with severe RP and refractory digital ulceration to detect ulnar artery occlusive disease.
    • Ulnar artery revascularization, with or without digital sympathectomy, should be considered for patients with confirmed ulnar artery occlusion who do not respond to conventional medical therapy.