Chap 122 Raynauds

Question 1

What is the cause of primary raynauds?

Answer 1

idiopathic

Question 2

What are connective tissue causes of secondary raynauds?

Answer 2

systemic sclerosis
inflammaroty muscle disease
Lupus
Sjogren's syndrome
Vasculitis

Question 3

What drugs can cause secondary raynauds?

Answer 3

BB
clonidine
ergotamine
vinyl chloride

Question 4

What occupational cause can cause raynauds?

Answer 4

HAVS

TOS

Question 5

What illness that impair digital perfusion can cause secondary raynauds?

Answer 5

paraproteinemia
cryoglobulinemia
malignancy

Question 6

What are some large vessel disease that can cause secondary raynauds?

Answer 6

athero

thromboangitis obliterans

Question 7

What are proposed pathogenic cases of raynauds?

Answer 7

vascular
impaired vasod (impaired NO and prostacyclin)
increased vasoconstriction (overproduction of ATII, ET-1)
structural vascular abnormalities

Neural
impaired vasod (calcitonin gene related peptide)
increased vasoc (abnormal adrenergic function)
central (stress induced)

Intravascular factos (plt WBC activation, increased thrombin generation)

Genetic

Question 8

What are important questions on hx?

Answer 8

tissue loss
CTD (difficulty swallowing, photosensitivity, mouth ulcers)
asymmetry
what drugs
occupational hx
fam hx
RF for athero
bruits, pulses

Question 9

What investigations to do for raynauds?

Answer 9

nailfold cappilaroscopy (abnormalities)
angio/NIV for large vessel
Thermography (normal thermal gradients at room temp for PRP but not for sclerosis)

Question 10

What is medical therapy for raynauds?

Answer 10

remove triggers
CCB
ACEi
phosphodiesterase inhibitors
topical NO, nitrate

Question 11

When to do sx? what sx options for raynauds?

Answer 11

when medical  treatment fails
ulcer debridement
cervical sympathectomy (symptoms may return)
periarterial symapthectomy 
Balloon angio
arterial reconstruction
excision of calcific deposits
amputation
botox injections

Question 12

What is the angio anatomic classification of raynauds?

Answer 12

type I: occlusion of R or U artery, decreased flow in level 2-3 arteries
type II: as I but with stenosis of R or U artery
type IIIa: main disorder in common digital or digital arteries
type IIIb: rare, occlusion of the digital arteries to index finger caused by vibration
type IV: all level stenotic
Type V: global ischemia, paucity of vessels, scant flow on angio

Question 13

What is the technique for digital sympathectomy?

Answer 13

bruner Z-shaped incision

stripp adventitia of common digital artery

Question 14

How many neurone are in the motor sympathetic route?

Answer 14

3

Question 15

Where is the thoracic sympathetic trunk located?

Answer 15

in the middle of the intercostal space either bottom edge of top rib or top edge of bottom rib

Question 16

Name indications for cervicothoracic sympathectomy

Answer 16

essential hyperhidrosis
ischemia of the hand
CRPS
Long QT syndrome
Raynauds

Question 17

What are surgical approaches to sympathectomy?

Answer 17

paravertebral
transthoracic
supraclavicular
VATS (gold standard)

Question 18

What is the target for CRPS vascular disease and raynauds?

Answer 18

stellate, G2 and G3

Question 19

What are results of sympathectomy for raynauds?

Answer 19

50% dissatifaction
60% compensatory hyperhidrosis
may no longer be recommended

Question 20

What are results of sympathectomy for CRPS?

Answer 20

Success 85% needs to be done early

Question 21

What are common complications to sympathectomy?

Answer 21

Compensatory sweating
Segmental atelectasis
Penumo
Subcut emphysema

Question 22

What are rare complications of sympathectomy?

Answer 22

Horners
Hemo
Effusion
Injry to vagus, phrenic, scla, sclv

Question 23

What are causes of failure of sympathectomy?

Answer 23

Incomplete denervation
Regeneration
Functional reorganization

Question 23

What arête appears to be preferentially affected in secondary raynauds?

Answer 23

Ulnar