Interventional techniques for the management of digital ischemia due to Raynaud’s phenomenon

Digital ischemia secondary to Raynaud’s phenomenon (RP) presents a significant challenge to clinicians because its symptoms are progressive, painful, and often unresponsive to medical management or conservative measures. The associated symptoms (pallor, cyanosis, and pain) can profoundly affect quality of life and are associated with significant morbidity, including ulceration, infection, and gangrene. Given the limitations of medical management and conservative therapies, a number of interventional and surgical techniques may be considered for treatment of pain and ischemic symptoms: peripheral nerve blockade of the brachial plexus, botulinum toxin injections, stellate ganglion blockade, spinal cord stimulation, and surgical sympathectomy. Data regarding RP are currently limited to case reports, case series, and retrospective reviews. To this date none of these interventional and surgical techniques have been evaluated individually or head to head in prospective clinical trials. This article reviews the current surgical and interventional treatment options for digital ischemia secondary to RP to allow clinicians to familiarize themselves with the available alternatives for patients whose symptoms are severe or unresponsive to medical management. Further research is needed to determine the optimal interventional treatment options for patients suffering from this debilitating disorder.