Chap 122 Raynauds Flashcards
What is the cause of primary raynauds?
idiopathic
What are connective tissue causes of secondary raynauds?
systemic sclerosis inflammaroty muscle disease Lupus Sjogren's syndrome Vasculitis
What drugs can cause secondary raynauds?
BB
clonidine
ergotamine
vinyl chloride
What occupational cause can cause raynauds?
HAVS
TOS
What illness that impair digital perfusion can cause secondary raynauds?
paraproteinemia
cryoglobulinemia
malignancy
What are some large vessel disease that can cause secondary raynauds?
athero
thromboangitis obliterans
What are proposed pathogenic cases of raynauds?
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
What are important questions on hx?
tissue loss CTD (difficulty swallowing, photosensitivity, mouth ulcers) asymmetry what drugs occupational hx fam hx RF for athero bruits, pulses
What investigations to do for raynauds?
nailfold cappilaroscopy (abnormalities)
angio/NIV for large vessel
Thermography (normal thermal gradients at room temp for PRP but not for sclerosis)
What is medical therapy for raynauds?
remove triggers CCB ACEi phosphodiesterase inhibitors topical NO, nitrate
When to do sx? what sx options for raynauds?
when medical treatment fails ulcer debridement cervical sympathectomy (symptoms may return) periarterial symapthectomy Balloon angio arterial reconstruction excision of calcific deposits amputation botox injections
What is the angio anatomic classification of raynauds?
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
What is the technique for digital sympathectomy?
bruner Z-shaped incision
stripp adventitia of common digital artery
How many neurone are in the motor sympathetic route?
3
Where is the thoracic sympathetic trunk located?
in the middle of the intercostal space either bottom edge of top rib or top edge of bottom rib
Name indications for cervicothoracic sympathectomy
essential hyperhidrosis ischemia of the hand CRPS Long QT syndrome Raynauds
What are surgical approaches to sympathectomy?
paravertebral
transthoracic
supraclavicular
VATS (gold standard)
What is the target for CRPS vascular disease and raynauds?
stellate, G2 and G3
What are results of sympathectomy for raynauds?
50% dissatifaction
60% compensatory hyperhidrosis
may no longer be recommended
What are results of sympathectomy for CRPS?
Success 85% needs to be done early
What are common complications to sympathectomy?
Compensatory sweating
Segmental atelectasis
Penumo
Subcut emphysema
What are rare complications of sympathectomy?
Horners
Hemo
Effusion
Injry to vagus, phrenic, scla, sclv
What are causes of failure of sympathectomy?
Incomplete denervation
Regeneration
Functional reorganization
What arête appears to be preferentially affected in secondary raynauds?
Ulnar
