Vasospastic and Ischemic Disorders of the Upper Extremity: Vascular Radiology Collaborations Guiding Raynaud’s Treatment Strategies

BACKGROUND: Raynaud's phenomenon (RP) encompasses vasospastic disorders that can progress to digital ischemia, ulceration, and tissue loss. Despite multiple therapeutic options, variability in diagnostic evaluation and procedural indications can delay appropriate treatment. This review summarizes current evidence on RP and presents a structured diagnostic pathway and treatment algorithm for patients with vasospastic disease and digital ischemia. METHODS: A review of contemporary literature on the epidemiology, pathophysiology, diagnostic studies and therapeutic interventions for RP was collected. Additionally, we describe our institution's algorithm which integrates noninvasive vascular diagnostics, catheter angiography with vasodilation challenges and a stepwise approach to procedure selection based on patterns of vasospasm and occlusion. RESULTS: Primary RP is a vasospastic disorder whereas secondary RP involves vasospasm and fixed occlusive disease. Noninvasive studies help assess wound healing potential and abnormal results will lead to an interventional radiology consultation for catheter angiography. Angiography defines the level of disease, responsiveness to vasodilators and suitability for intervention. Interventions include chemical and mechanical sympathectomy which is most suitable in patients with vasospastic disease and less effective in secondary RP. Patients with segmental occlusions and patent distal targets or with secondary RP will benefit from open arterial bypass or arterial reconstruction. Patients with disease isolated to the proper digital arteries are not amenable to targeted surgical interventions due to the risk of worsening ischemia. CONCLUSIONS: A structured, physiology-guided diagnostic and treatment algorithm can improve the precision of RP management. Integrating noninvasive testing with angiography allows tailored use of sympathectomy and reconstruction in these patients.