Cold sensitivity of the hand in arterial occlusive disease

Digital blood pressure was measured using photoplethysmography in patients with cold sensitivity of the hand. In 19 patients with Buerger's disease, or arteriosclerosis obliterans (arterial occlusion group), 90 of 91 fingers with cold sensitivity showed significantly low pressures. In 17 patients with typical Raynaud's phenomena due either to primary Raynaud's disease or secondary to collagen disease (Raynaud's group), decreased digital pressure was noted in only five of 123 fingers with cold sensitivity. Blood pressure measurements in the fingers after local cooling of the hand showed a more severe response to cold in the Raynaud group than in the arterial occlusion group. These results indicate that the pathophysiologic mechanism for cold sensitivity in arterial occlusive disease is different from that in Raynaud's disease. In the arterial occlusion group impaired circulation due to occlusions in the digital arteries or more proximal arteries is a necessary precondition for cold sensitivity, and an increased sympathetic response to cold is of less importance as an etiologic factor. Thus a patient with cold sensitivity of the hand and normal digital blood pressure should not be considered to have arterial occlusive disease as the underlying cause of cold sensitivity.