Role of the vascular surgeon in the treatment of secondary Raynaud’s phenomenon, literature review and endovascular management proposal


  • Carlos P. Achurra-Godínez Department of Angiology, Vascular and Endovascular Surgery Service of the General Hospital of Mexico “Dr Eduardo Liceaga”, Mexico City, Mexico
  • Miguel A. Sierra-Juarez Department of Angiology, Vascular and Endovascular Surgery Service of the General Hospital of Mexico “Dr Eduardo Liceaga”, Mexico City, Mexico
  • Marlon E. Lacayo-Valenzuela Department of Angiology, Vascular and Endovascular Surgery Service of the General Hospital of Mexico “Dr Eduardo Liceaga”, Mexico City, Mexico



Raynaud’s phenomenon, Secondary Raynaud´s phenomenon, Raynaud´s syndrome, Prostaglandin E1, PGE1, Intraarterial


Raynaud´s phenomenon is a very common condition, usually little investigated due to its benign nature, however, when talking about Secondary Raynaud’s phenomenon, the situation can become very serious and even compromise the integrity of the extremities, it is then when it is important to know the multidisciplinary team that can and should intervene, as well as the treatment alternatives both medical, surgical and endovascular, this is where the extremely important role of the vascular surgeon in this condition comes in. A search was carried out in the main search engines of medical research (Pubmed, Ebsco host, Clinical key, Cochrane, and Springer Link) focused on the pathophysiology, diagnosis and treatment of Raynaud’s phenomenon, finding most of the bibliography in dermatology, rheumatology, plastic surgery and to a lesser extent angiology and vascular surgery. And share the experience we have had in endovascular management and its long-term results. We select about 45 papers from different topics for made this recompilation trying to include the different approaches by specialty and emphasize in the management that the vascular surgeon could offer and present the experience obtained in some patients in our hospital. Secondary Raynaud´s phenomenon can be a mutilating condition that is usually managed exclusively by rheumatology and dermatology, however in selected (complex) cases the intervention of the vascular surgeon can make a difference in the integrity of the limbs and the quality of life of our patients.


Maverakis E, Patel F, Kronenberg DG, Chung L, Fiorentino D, Allanore Y, et al. International consensus criteria for the diagnosis of Raynaud’s phenomenon. J Autoimmun. 2014;48-49:60-5.

Belch J, Carlizza A, Carpentier PH, Constans J, Khan F, Claude WJ, et al. ESVM guidelines – the diagnosis and management of Raynaud’s phenomenon. Vasa. 2017;46(6):413-23.

Reiser M, Bruns C, Hartmann P, Salzberger B, Diehl V, Fätkenheuer G. Raynaud’s phenomenon and acral necrosis after chemotherapy for AIDS-related Kaposi’s sarcoma. Eur J Clin Microbiol Infect Dis. 1998;17(1):58-60.

Herrick AL. The pathogenesis, diagnosis and treatment of Raynaud phenomenon. Nat Rev Rheumatol. 2012;8(8):469-79.

Cutolo M, Sulli A, Smith V. Assessing microvascular changes in systemic sclerosis diagnosis and management. Nat Rev Rheumatol. 2010;6(10):578-87.

Cappelli L, Wigley FM. Management of Raynaud Phenomenon and Digital Ulcers in Scleroderma. Rheum Dis Clin North Am. 2015;41(3):419-38.

Pauling JD, O’donnell VB, Mchugh NJ. The contribution of platelets to the pathogenesis of Raynaud’s phenomenon and systemic sclerosis. Platelets. 2013;24(7):503-15.

Flavahan NA, Flavahan S, Mitra S, Chotani MA. The vasculopathy of Raynaud’s phenomenon and scleroderma. Rheum Dis Clin North Am. 2003;29(2):275-91.

Kowal-Bielecka O, Fransen J, Avouac J, Becker M, Kulak A, Allanore Y, et al. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis. 2017;76(8):1327-39.

Stringer T, Femia AN. Raynaud’s phenomenon: Current concepts. Clin Dermatol. 2018;36(4):498-507.

Herrick AL, Wigley FM. Raynaud’s phenomenon. Best Pract Res Clin Rheumatol. 2020;34(1):101474.

Chaparro YC, González Gómez A, Carvajal Flechas F, Rojas C, Darío-Mantilla R, Rojas-Villarraga A. Detection of vascular changes in Raynaud’s phenomenon when capillaroscopy and thermography are used. Systematic literature review. Rev Colomb Reumatol (English Ed). 2023;0(2):137-49.

Smith V, Ickinger C, Hysa E, Snow M, Frech T, Sulli A, et al. Nailfold capillaroscopy. Best Pract Res Clin Rheumatol. 2023;28(5):101849.

Brennan P, Silman A, Black C, Bernstein R, Coppock J, Maddison P, et al. Validity and reliability of three methods used in the diagnosis of raynaud’s phenomenon. Rheumatology. 1993;32(5):357-61.

Wigley FM. Raynaud’s Phenomenon. N Engl J Med. 2002;347(13):1001-8.

Landry GJ. Current medical and surgical management of Raynaud’s syndrome. J Vasc Surg. 2013;57(6):1710-6.

Thompson AE, Pope JE. Calcium channel blockers for primary Raynaud’s phenomenon: A meta-analysis. Rheumatology. 2005;44(2):145-50.

Ennis H, Hughes M, Anderson ME, Wilkinson J, Herrick AL. Calcium channel blockers for primary Raynaud’s phenomenon. Cochrane Database Syst Rev. 2016;2016(2).

Investigation O. Comparison of Sustained-Release Nifedipine and Temperature Biofeedback for Treatment of Primary Raynaud Phenomenon. Arch Intern Med. 2000;160(8):1101.

Harding SE, Tingey PC, Pope J, Fenlon D, Furst D, Shea B, et al. Prazosin for Raynaud’s phenomenon in progressive systemic sclerosis. Cochrane Database Syst Rev. 1998;2:CD000956.

Coleiro B, Marshall SE, Denton CP, Howell K, Blann A, Welsh KI, et al. Treatment of Raynaud’s phenomenon with the selective serotonin reuptake inhibitor fluoxetine. Rheumatology. 2001;40(9):1038-43.

Fries R, Shariat K, Von Wilmowsky H, Böhm M. Sildenafil in the treatment of Raynaud’s phenomenon resistant to vasodilatory therapy. Circulation. 2005;112(19):2980-5.

Chung L, Shapiro L, Fiorentino D, Baron M, Shanahan J, Sule S, et al. MQX-503, a novel formulation of nitroglycerin, improves the severity of Raynaud’s phenomenon. Arthritis Rheum. 2009;60(3):870-7.

Matucci-Cerinic M, Denton CP, Furst DE, Mayes MD, Hsu VM, Carpentier P, et al. Bosentan treatment of digital ulcers related to systemic sclerosis: results from the RAPIDS-2 randomised, double-blind, placebo-controlled trial. Ann Rheum Dis. 2011;70(1):32-8.

Weiss T. Mode of action of prostaglandin E1 in the treatment of peripheral arterial disease. Vasa - J Vasc Dis. 2003;32(4):187-92.

Sun Y, Rui WH, Hang FX, Feng WK. Efficacy of prostaglandina E1 for the treatment of patients with thrombo-occlusive vasculitis. Medicine (Baltimore). 2020;99(22):e20369.

Creutzig A, Caspary L, Alexander K. Skin surface oxygen pressure fields during administration of prostaglandin E1 in patients with arterial occlusive disease. Klin Wochenschr. 1990;68(4):207-12.

Braune S, Küpper JH, Jung F. Effect of prostanoids on human platelet function: An overview. Int J Mol Sci. 2020;21(23):1-20.

Motoyama Y, Sakata Y, Seki J, Sato M, Namikawa Y, Horiai H, et al. TFC-612, a prostaglandin E1 derivative, enhances fibrinolytic activity in rats. Thromb Res. 1992;65(1):55-63.

Kingma K, Wollersheim H, Thien T. Double-Blind, Placebo-Controlled Study of Intravenous Prostacyclin on Hemodynamics in Severe Raynaudʼs Phenomenon. J Cardiovasc Pharmacol. 1995;26(3):388-93.

Torley HI, Madhok R, Capell HA, Brouwer RML, Maddison PJ, Black CM, et al. A double blind, randomised, multicentre comparison of two doses of intravenous iloprost in the treatment of Raynaud’s phenomenon secondary to connective tissue diseases. Ann Rheum Dis. 1991;50(11):800-4.

Katoh K, Kawai T, Narita M, Uemura J, Tani K, Okubo T. Use of prostaglandin E1 (lipo‐PGEi) to treat Raynaud’s phenomenon associated with connective tissue disease: thermographic and subjective assessment. J Pharm Pharmacol. 1992;44(5):442-4.

Leng C, Lin G, Cao H, Liu Z. Multidisciplinary Treatment for Severe Secondary Raynaud’s Phenomenon: A Case Report. Chinese Med Sci J. 2022;37:353-8.

Gardinali M, Pozzi MR, Bernareggi M, Montani N, Allevi E, Catena L, et al. Treatment of Raynaud’s phenomenon with intravenous prostaglandin E1α-cyclodextrin improves endothelial cell injury in systemic sclerosis. J Rheumatol. 2001;28(4):786-94.

Jenkins SN, Neyman KM, Veledar E, Chen SC. A pilot study evaluating the efficacy of botulinum toxin A in the treatment of Raynaud phenomenon. J Am Acad Dermatol. 2013;69(5):834-5.

Coveliers HME, Hoexum F, Nederhoed JH, Wisselink W, Rauwerda JA. Thoracic sympathectomy for digital ischemia: A summary of evidence. J Vasc Surg. 2011;54(1):273-7.

Balogh B, Mayer W, Vesely M, Mayer S, Partsch H, Piza-Katzer H. Adventitial stripping of the radial and ulnar arteries in Raynaud’s disease. J Hand Surg Am. 2002;27(6):1073-80.

Vegas DH, Fabiani MA, Gonzalez-Urquijo M, Bignotti A, Seré I, Salvadores P. Novel Combined Approach for Digital Necrosis Secondary to Raynaud’s Phenomenon. Vasc Endovascular Surg. 2021;55(7):766-71.

Han KR, Kim C, Park EJ. Successful treatment of digital ulcers in a scleroderma patient with continuous bilateral thoracic sympathetic block. Pain Physician. 2008;11(1):91-6.

Mannava S, Plate JF, Stone A V., Smith TL, Smith BP, Koman LA, et al. Recent advances for the management of raynaud phenomenon using botulinum neurotoxin A. J Hand Surg Am. 2011;36(10):1708-10.

Kaada B. Vasodilation induced by transcutaneous nerve stimulation in peripheral ischemia (raynaud’s phenomenon and diabetic polyneuropathy). Eur Heart J. 1982;3(4):303-14.

Sibell DM, Colantonio AJ, Stacey BR. Successful use of spinal cord stimulation in the treatment of severe Raynaud’s disease of the hands. Anesthesiology. 2005;102(1):225-7.

Giglio M, Preziosa A, Rekatsina M, Viswanath O, Urits I, Varrassi G, et al. Successful Spinal Cord Stimulation for Necrotizing Raynaud’s Phenomenon in COVID-19 Affected Patient: The Nightmare Comes Back. Cureus. 2021;13(4).

Curtiss P, Svigos K, Schwager Z, Lo Sicco K, Franks AG. Part II: The Treatment of Primary and Secondary Raynaud’s Phenomenon. J Am Acad Dermatol. 2022;6.

Kawakami T, Kawasaki K, Mizoguchi M, Soma Y. Therapeutic effect of lipoprostaglandin E1 on livedoid vasculitis associated with essential cryoglobulinaemia. Br J Dermatol. 2007;157(5):1051-3.

Tyler G, Clark RA, Jacobson ED. Nonocclusive intestinal ischemia treated with intraarterial infusion of prostaglandin E1. Cardiovasc Intervent Radiol. 1982;5(1):16-9.

Weiss T, Griesshaber J, Rogatti W, Wilhelm C, Diehm C, Kübler W. Intraindividual evaluation of the optimal PGE1 application route in critical limb ischemia. Int J Angiol. 1994;3(1):191-4.

Huk I, Brovkovych V, Nanobashvili J, Neumayer C, Polterauer P, Prager M, et al. Prostaglandin E1 reduces ischemia/reperfusion injury by normalizing nitric oxide and superoxide release. Shock. 2000;14(2):234-42.

National Center for Biotechnology Information. PubChem Compound Summary for CID 5280723, Alprostadil. 2023. Available at: https://pubchem. Accessed on 11 November 2023.






Review Articles