Radial Artery Occlusion in Raynaud's Disease

Lee S. Simon, MD

Disclosures

May 22, 2001

Question

A 35-year-old woman recently presented with bilateral hand and finger pain with color changes. Initial diagnosis was Raynaud's disease. The condition worsened, and angiography revealed bilateral radial artery occlusion. At bypass surgery, a biopsy showed merely thrombosis (after 2 weeks of high-dose corticosteroid therapy). Five years earlier, a flare-up in this patient had included arthritis in the hands and knees, malar rash, stomatitis, and alopecia; these symptoms resolved with steroids over several months.

All tests, including antinuclear antibodies, rheumatoid factor, anticardiolipin antibodies, lupus anticoagulant, and coagulation studies have been negative. How should I follow and treat this patient after the surgical intervention is complete?

Susan Berkebile, MD

Response from Lee S. Simon, MD

You describe a difficult problem. The cause of the occlusion remains troubling because all studies to determine whether there is a hypercoagulable state are negative. Given that the patient has significant vascular spasm, which is the presumed etiology of the event, then the key would be to decrease the spasm if possible with a calcium channel blocker (if the patient's blood pressure can tolerate it) and consider low-dose aspirin to decrease platelet aggregation. As usual in the context of significant spasm of the vessels with Raynaud's, local care and warm mittens, etc., are very important.

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