Periarterial sympathectomy and arterial bypass are microsurgical techniques which the literature suggests can provide improvement in digital pain and ulceration in patients with systemic sclerosis who have persistent symptoms despite medication management. This review summarizes the relevant anatomy, medical therapies, operative techniques, and surgical outcomes and complications associated with the management of the vascular manifestations of systemic sclerosis in the hand. Multidisciplinary collaboration between dermatology, rheumatology, and hand surgery can facilitate optimal medical and surgical management for systemic sclerosis patients.
BogochEGrossD.Surgery of the hand in patients with systemic sclerosis: outcomes and considerations. J Rheumatol2005; 32(4): 642–648.
2.
KomanLARuchDSAldridgeM, et al. Arterial reconstruction in the ischemic hand and wrist: effects on microvascular physiology and health-related quality of life. J Hand Surg1998; 23(5): 773–782.
3.
KotsisSVChungKC.A systematic review of the outcomes of digital sympathectomy for treatment of chronic digital ischemia. J Rheumatol2003; 30(8): 1788–1792.
4.
MomeniASoriceSCValenzuelaA, et al. Surgical treatment of systemic sclerosis–is it justified to offer peripheral sympathectomy earlier in the disease process?Microsurgery2015; 35(6): 441–446.
5.
MurataKOmokawaSKobataY, et al. Long-term follow-up of periarterial sympathectomy for chronic digital ischaemia. J Hand Surg Eur Vol2012; 37(8): 788–793.
6.
RuchDSAldridgeMHoldenM, et al. Arterial reconstruction for radial artery occlusion. J Hand Surg Am2000; 25(2): 282–290.
7.
SavvidouCTsaiT.Long-term results of arterial sympathectomy and artery reconstruction with vein bypass technique as a salvage procedure for severe digital ischemia. Ann Plast Surg2013; 70(2): 168–171.
8.
WardWAVan MooreA.Management of finger ulcers in scleroderma. J Hand Surg Am1995; 20(5): 868–872.
9.
ChiouGCroweCSuarezP, et al. Digital sympathectomy in patients with scleroderma: an overview of the practice and referral patterns and perceptions of rheumatologists. Ann Plast Surg2015; 75(6): 637–643.
10.
PedersonW. Vascular disorders of the hand. In: WolfeSWHotchkissRNPedersonWC, et al. (eds) Green’s operative hand surgery. 7th ed.Philadelphia, PA: Elsevier, Inc., 2017, pp. 2036–2059.
11.
LeversedgeFJGoldfarbCABoyerM.A pocketbook manual of hand and upper extremity anatomy: primus manus. Philadelphia, PA: Lippincott Williams & Wilkins, 2010.
12.
ColemanSSAnsonBJ.Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet1961; 113: 409–424.
13.
IkedaAUgawaAKaziharaY, et al. Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg Am1988; 13(4): 501–509.
14.
RuengsakulrachPEizenbergNFahrerC, et al. Surgical implications of variations in hand collateral circulation: anatomy revisited. J Thorac Cardiovasc Surg2001; 122(4): 682–686.
15.
RuchDSKomanLASmithTL.Chronic vascular disorders of the upper extremity. J Am Soc Surg Hand2001; 1(1): 73–80.
16.
KahalehMB.Raynaud’s phenomenon and vascular disease in scleroderma. Curr Opin Rheumatol1994; 6: 621–627.
17.
AbrahamSSteenV.Optimal management of digital ulcers in systemic sclerosis. Ther Clin Risk Manag2015; 11: 939–947.
18.
HughesMHerrickAL.Digital ulcers in systemic sclerosis. Rheumatology2017; 56(1): 14–25.
19.
WalkerKMPopeJ.Treatment of systemic sclerosis complications: what to use when first-line treatment fails–a consensus of systemic sclerosis experts. Semin Arthritis Rheum2012; 42(1): 42–55.
20.
ThompsonASheaBWelchV, et al. Calcium-channel blockers for Raynaud’s phenomenon in systemic sclerosis. Arthritis Rheum2001; 44(8): 1841–1847.
21.
DziadzioMDentonCPSmithROY, et al. Losartan therapy for Raynaud’s phenomenon and scleroderma: clinical and biochemical findings in a fifteen-week, randomized, parallel-group, controlled trial. Arthritis Rheum1999; 42(12): 2646–2655.
22.
GliddonAEDoréCJBlackCM, et al. Prevention of vascular damage in scleroderma and autoimmune Raynaud’s phenomenon: a multicenter, randomized, double-blind, placebo-controlled trial of the angiotensin-converting enzyme inhibitor quinapril. Arthritis Rheum2007; 56(11): 3837–3846.
23.
ChungLShapiroLFiorentinoD, et al. MQX-503, a novel formulation of nitroglycerin, improves the severity of Raynaud’s phenomenon. Arthritis Rheum2009; 60(3): 870–877.
24.
O’ReillyDTehLSManningJ, et al. Sustained-release transdermal glyceryl trinitrate patches as a treatment for primary and secondary Raynaud’s phenomenon. Rheumatology2007; 34(7): 636–641.
25.
WigleyFMHummersLKMichalekJ, et al. A multi-centre, blinded, randomised, placebo-controlled, laboratory-based study of MQX-503, a novel topical gel formulation of nitroglycerine, in patients with Raynaud phenomenon. Ann Rheum Dis2012; 72(12): 1962–1967.
26.
PopeJSilmanATingeyPC, et al. Prazosin for Raynaud’s phenomenon in progressive systemic sclerosis. Cochrane Database Syst Rev2003; 2: CD000956.
27.
Matucci-CerinicMDentonCPFurstDE, et al. Bosentan treatment of digital ulcers related to systemic sclerosis: results from the RAPIDS-2 randomised, double-blind, placebo-controlled trial. Ann Rheum Dis2010; 70(1): 32–38.
28.
ChungLBallKYaqubA, et al. Effect of the endothelin type A-selective endothelin receptor antagonist ambrisentan on digital ulcers in patients with systemic sclerosis: results of a prospective pilot study. J Am Acad Dermatol2014; 71(2): 400–401.
29.
DowdPMMartinMFRCookeED, et al. Treatment of Raynaud’s phenomenon by intravenous infusion of prostacyclin (PGI2). Br J Dermatol1982; 106(1): 81–89.
30.
BelchJJFNewmanPDruryJK, et al. Intermittent epoprostenol (prostacyclin) infusion in patients with Raynaud’s syndrome: a double-blind controlled trial. Lancet1983; 1(8320): 313–315.
31.
KyleMBelcherGHazlemanB.Placebo controlled study showing therapeutic benefit of iloprost in the treatment of Raynaud’s phenomenon. J Rheumatol1992; 19(9): 1403–1406.
32.
WigleyFMWiseRASeiboldJR, et al. Intravenous iloprost infusion in patients with Raynaud’s phenomenon secondary to systemic sclerosis: a multicenter, placebo-controlled, double-blind study. Ann Intern Med1994; 120: 199–206.
33.
RademakerMCookeEDAlmondNE, et al. Comparison of intravenous infusions of iloprost and oral nifedipine in treatment of Raynaud’s phenomenon in patients with systemic sclerosis: a double blind randomised study. BMJ1989; 298(6673): 561–564.
34.
ColeiroBMarshallSDentonC, et al. Treatment of Raynaud’s phenomenon with the selective serotonin reuptake inhibitor fluoxetine. Rheumatology2001; 40(9): 1038–1043.
BellCCouplandNCreamerP.Digital infarction in a patient with Raynaud’s phenomenon associated with treatment with a specific serotonin reuptake inhibitor: a case report. Angiology1996; 47(9): 901–903.
37.
KuwanaMOkazakiYKaburakiJ.Long-term beneficial effects of statins on vascular manifestations in patients with systemic sclerosis. Mod Rheumatol2009; 19(5): 530–535.
38.
Abou-RayaAAbou-RayaSHelmiiM.Statins: potentially useful in therapy of systemic sclerosis-related Raynaud’s phenomenon and digital ulcers. J Rheumatol2008; 35(9): 1801–1808.
39.
CappelliLWigleyFM.Management of Raynaud phenomenon and digital ulcers in scleroderma. Rheum Dis Clin North Am2015; 41(3): 419–438.
40.
FoxPChungLChangJ.Management of the hand in systemic sclerosis. J Hand Surg Am2013; 38(5): 1012–1016; quiz 1017.
41.
JonesNFImbrigliaJESteenVD, et al. Surgery for scleroderma of the hand. J Hand Surg Am1987; 12(3): 391–400.
42.
WilliamsAACarlHMLifchezSD.The scleroderma hand: manifestations of disease and approach to management. J Hand Surg Am2018; 43(6): 550–557.
43.
HartzellTLMakhniECSampsonC.Long-term results of periarterial sympathectomy. J Hand Surg Am2009; 34(8): 1454–1460.
44.
AllanoreYSerorRChevrotA, et al. Hand vascular involvement assessed by magnetic resonance angiography in systemic sclerosis. Arthritis Rheum2007; 56(8): 2747–2754.
