Background/Purpose: Raynaud’s phenomenon (RP) seen in patients with an underlying autoimmune rheumatic disorder have both functional and structural dysfunction at the microvascular level and in more severe forms at the macrovascular level; leading to the characteristic clinical picture. In most cases, preventive actions and pharmacotherapy can be of help. However, a more severe subgroup of patients may develop painful ulcerations, gangrene and digital amputations that are difficult to control. In medication refractory RP, and when medium vessel involvement is identified, surgical revascularization has been attempted. Previous studies have examined the short-term results of revascularization; however long-term outcomes in autoimmune medication refractory RP patients are limited.

Methods: Following Institutional Review Board approval, patients at the University of Pennsylvania between 2009-2019 were identified based on ICD-9 and 10 diagnosis codes for systemic sclerosis (Ssc), Raynaud’s and vascular grafting. The patients within the study fulfilled the ACR/EULAR 2013 classification criteria for SSc. Retrospective chart review for pre and postoperative patient reported symptoms, clinical exam findings, and imaging results were collected. Long-term results for digital ulcers, pain, color change and occlusion were compared.

Results: Nine patients, 10 hands (with no prior revascularization), were identified to meet the inclusion criteria. The majority of the patients were female and older than 45 years at surgery. Complete occlusion was noted in all hands at surgery, with revascularization occurring almost exclusively in the ulnar artery, and venous graft most often obtained from the lower extremity. There were no surgical complications and Doppler ultrasound was used to confirm pulsatile blood flow through graft and digits prior to closing. Patients were followed for an average of 24 months with 3 patient deaths within the first two years and one patient who transferred medical care. All other patients are still being followed for symptoms. Ongoing and unremitting digital ulcers, pain and color change were noted in 2 patients, both who had medication mal-adherence. The other patients had subjective and objective resolution, or decrease in digital ulcers, pain, color change (inconsistently noted) and no occlusions.

Conclusion: This is the first long term study to follow patients and attempt to measure the benefits of arterial revascularization in medication refractory SSc -RP patients through digital ulcer, pain, color change and occlusion occurrence. At follow-up, the majority of the hands showed improvement or resolution of Raynaud’s symptoms even months – years later.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-outcomes-of-vascular-grafting-of-medium-sized-vessels-of-the-wrist-and-hand-in-patients-with-medication-refractory-systemic-sclerosis-related-raynauds-phenomenon-at-the-university-o/