Editor-in-Chief: Kenneth D. Candido, MD
The etiology of Raynaud’s syndrome is characterized by inappropriate vascular constriction of digits and extremities from a complex interaction between the sympathetic nervous system, vascular endothelium, and the paracrine/endocrine system. Secondary Raynaud’s, complicated by autoimmunity, is generally more severe and was not expected to respond to sympathetic blocks. Our report demonstrates profound improvement of angiographically confirmed severe secondary Raynaud’s following stellate ganglion block, with resolution of multiple nonhealing digital ulcers.
A 53-year-old woman with mixed connective tissue disease and idiopathic thrombocytopenic purpura (ITP) presented with right hand pain, severe ischemic changes, and several areas of nonhealing digital ulcerations. Maximal medical management had provided transient symptomatic improvement. When angiographic findings of diffuse vasospasm on the right suggested increased sympathetic tone, we performed a trial of stellate ganglion blocks. The first block immediately improved vasoconstriction and pain. Over 7 months she underwent three series of weekly injections (11 total injections). Slow healing of her ulcerations occurred. At 6-month follow-up, her ulcerations remained healed.
Prior reports had indicated stellate ganglion or sympathetic blocks are ineffective or contraindicated in secondary Raynaud’s. The resolution of dry gangrene resulting in digit salvage after serial stellate ganglion blocks suggests that increased sympathetic tone may be a mechanism of disease in secondary Raynaud’s. Despite prior reports to the contrary, some patients may benefit from a trial of sympathetic blocks before undergoing surgical sympathectomy.
Key words: Raynaud’s syndrome, mixed connective tissue disorder, stellate ganglion block, peripheral ischemia, secondary Raynaud’s, sympathectomy