Raynaud's syndrome: diagnosis and treatment

Patient care and research in clinical vascular surgery have traditionally and appropriately focused on the complications of atherosclerosis. Without question, however, the clinical field of vascular surgery encompasses a number of areas other than clinical vasospasm as exemplified by Raynaud's syndrome. At the Clinical Research Center at the Oregon Health Sciences University, during the past 20 years the vascular surgery unit has maintained an active research program in Raynaud's syndrome and to date has enrolled and longitudinally followed more than 1000 patients with this affliction. There has been an opportunity to participate in the long-term management of this large population with emphasis both on natural history and vascular laboratory diagnosis and treatment. Raynaud's syndrome is a condition characterized by episodic digital ischemia in response to cold or emotional stimuli. The incidence is greater in women, and it is more frequent in areas with a cool, damp climate. Raynaud's usually affects the hands and fingers, but it may affect the feet and toes as well. The classical Raynaud's attack is tricolor and consists of blanching of the digits resulting from cessation of arterial flow, then cyanosis upon rewarming. This is followed by reactive hyperemia, which causes the digits to turn red. Raynaud's syndrome is classified into two groups: vasospastic or obstructive. Vasospastic Raynaud's is generally cold-induced. Nicotine, stress, and caffeine are associated with vasospasm. Obstructive Raynaud's is observed in association with other diseases such as connective tissue disorders, atherosclerosis, traumatic occlusion, Buerger's disease, and occupational related disorders. The diagnosis of Raynaud's is based on differentiating between vasospasm and obstruction and detecting the presence of associated disease.(ABSTRACT TRUNCATED AT 250 WORDS)