ADVENTITIAL STRIPPING - A DIGIT SAVING PROCEDURE IN REFRACTORY RAYNAUDS-PHENOMENON

Objective. To assess the efficacy and role of adventitial stripping (i .e., digital sympathectomy) in patients with severe digital ischemia s econdary to refractory Raynaud's phenomenon (RP). Methods. A retrospec tive chart review of 13 consecutive cases of adventitial stripping in 9 patients with severe secondary RP was performed, examining patient c haracteristics, previous therapeutic interventions, and postoperative outcomes. An illustrative case is presented. Results. All identified p atients had evidence of systemic disease. After adventitial stripping, sustained longterm improvement was achieved in all 13 ischemic digits , 8 of which showed amelioration of symptoms immediately after surgery . In 2 patients, sustained improvement was noted despite progressive i schemia in nonoperated digits. The mean followup time was 28 months (r ange 10 to 47). No postoperative complications were observed. Pre-oper ative sympathetic nerve blockade was performed in 12 of the cases, of which 10 showed no clinical response. Pathologic specimens revealed ad ventitial fibrosis that caused extrinsic compression of the digital ar teries. Conclusion, Adventitial stripping of digital arteries is an ex tremely effective and safe option for patients with severe digital isc hemia secondary to refractory RP. The efficacy of this procedure resul ts not only from sympathetic denervation but also from decompression o f the ischemic vessel through removal of a fibrotic and noncompliant a dventitia. Because of the effects of this extrinsic vascular compressi on, lack of response to pre-operative sympathetic nerve blockade is no r predictive of postoperative outcomes.