Digital artery reconstruction with interposition vein graft: impact on secondary Raynaud's phenomenon.

Abstract

Patients with secondary Raynaud's phenomenon show a wide range of symptoms depending on the condition of vascular structures. If the symptoms are localized to specific fingers and angiography reveals a discrete segment of occlusion of a proper digital artery, we perform proper digital artery reconstruction with an interposition vein graft. The objective of this study was to evaluate the results of the surgery in patients with chronic hand ischemia. A retrospective chart review was performed on patients who underwent proper digital artery reconstruction. Each digit that underwent grafting was analysed separately. The results of surgical intervention and recurrence based on patient symptoms were evaluated. Cox proportional hazards regression models were used to identify independent risk factors associated with recurrence, and the Kaplan-Meier method was used to predict the 5-year recurrence-free rate. A total of 79 digits from 57 patients were included in this study. The majority of patients demonstrated resolution of ischemic pain and ulceration (97.5% and 95.3%, respectively). Recurrence occurred in 16 (20.3%) patients during the follow-up period. In two cases (2.5%) surgery had no effect. In the multivariate Cox regression analysis, smoking and concomitant periarterial sympathectomy were significant factors associated with recurrence. In the Kaplan-Meier analysis, the 5-year recurrence-free rate in the total study population was 69.3%. Digital artery reconstruction using an interposition vein graft is an effective procedure for improving ischemic pain and ulceration in patients with Raynaud's phenomenon. Smoking and concomitant periarterial sympathectomy were significantly associated with recurrence.