Angiography

Most patients with Raynaud’s phenomenon warrant no vascular evaluation. However, those patients with findings consistent with persistent digital ischemia in between episodes of vasospasm should be further interrogated. Unilateral symptoms, atherosclerotic risk factors, associated connective tissue disorders, and tissue loss are among the clues that should heighten one’s suspicion that there is a fixed arterial obstruction. After the vascular laboratory has confirmed arterial ischemia, angiography is warranted. The gold standard remains digital subtraction angiography during which endovascular intervention is possible. However, it is invasive and carries low but finite risks. Non-invasive alternatives include computed tomographic angiography which not only images the vessels, but also the vessel’s wall and surrounding tissues. Unfortunately, the imaging resolution is not ideal particularly at the distal ends of the extremities which are frequently the vessels of most concern in this patient population. Another option is magnetic resonance angiography which may accurately image medium and small vessels, but is highly dependent upon the technique used and the interpreting radiologist.