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Adventitial stripping: a digit saving procedure in refractory Raynaud's phenomenon
A M Yee1, R N Hotchkiss, S A Paget
1Division of Rheumatic Diseases, Hospital for Special Surgery/Cornell University Medical College, New York, NY 10021, USA.
The Journal of Rheumatology
|March 7, 1998
Summary
Adventitial stripping effectively treats severe digital ischemia in Raynaud's phenomenon (RP). This safe procedure relieves vessel compression from fibrosis, improving blood flow to digits.
Area of Science:
- Vascular Surgery
- Cardiology
- Rheumatology
Background:
- Refractory Raynaud's phenomenon (RP) can cause severe digital ischemia.
- Digital ischemia significantly impacts patient quality of life.
- Limited treatment options exist for severe, refractory cases.
Observation:
- A retrospective review of 13 cases of adventitial stripping in 9 patients with severe secondary RP was conducted.
- Patients had underlying systemic diseases contributing to digital ischemia.
- Follow-up averaged 28 months, with no observed postoperative complications.
Findings:
- Adventitial stripping led to sustained long-term improvement in all 13 ischemic digits.
- Eight digits showed immediate symptom amelioration post-surgery.
- Pathology revealed adventitial fibrosis causing extrinsic digital artery compression.
Implications:
- Adventitial stripping is a highly effective and safe treatment for severe digital ischemia in refractory RP.
- The procedure's success stems from both sympathetic denervation and decompression of fibrotic adventitia.
- Preoperative sympathetic nerve blockade response does not predict surgical outcomes due to extrinsic compression.
