Classification of Raynaud's disease based on angiographic features

Area of Science:

• Vascular Surgery
• Hand Surgery
• Radiology

Background:

• Accurate diagnosis and timely management are critical for preventing ischemic consequences in Raynaud's disease.
• Current lack of an objective classification hinders surgical planning for refractory cases.

Purpose of the Study:

• To propose and validate a new objective classification system for Raynaud's disease.
• To guide surgical planning and treatment selection for patients with refractory Raynaud's disease.

Main Methods:

• Analysis of angiographic features of hand arterial supply at three levels (radial/ulnar, palmar arch/common digital, digital vessels) in 178 patients (351 hands) undergoing surgery.
• Classification into six types based on occlusion, stenosis, tortuosity, and vessel paucity.
• Surgical interventions included digital sympathectomy, balloon angioplasty, and venous or arterial grafting, tailored to disease type.

Main Results:

• A six-type classification was established: Type I (27.3%) and II (26.2%) involve radial/ulnar arteries (complete/partial occlusion).
• Type IIIa (27.1%) involves digital vessels (tortuosity/stenosis), Type IIIb (1.4%) is vibration-related.
• Types IV (13.7%) and V (4.3%) show global involvement with diffuse stenosis or severe paucity of vessels.

Conclusions:

• The proposed classification system provides objective criteria for surgical decision-making in Raynaud's disease.
• This system is valuable for tailoring surgical procedures in patients refractory to conservative therapy.
• Nearly half of patients (47%) had associated systemic diseases, highlighting the complexity of Raynaud's management.