ab21404

The outcome of angiography in patients with Raynaud's phenomenon: An unexpected role for atherosclerosis and hypercholesterolemia

R.M. van Vugt, L. Kater, P.F. Dijkstra³, G.H.C. Schardijn⁴, J.J.P. Kastelein⁵, J.W.J. Bijlsma²

¹Department of Rheumatology and Clinical Immunology, Slotervaart Hospital, Amsterdam; ²Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht; ³Department of Diagnostic and Intervention Radiology, Academic Medical Center and Jan van Breemen Institute, Amsterdam; ⁴Consultant Rheumatologist, Amsterdam; ⁵Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.

ABSTRACT
Objectives
Upper extremity angiography can make an important contribution to the diagnosis in vasculopathy. The present study was designed to assess the diagnostic role of upper extremity angiography in patients with disturbed circulation of the hand, according to a standardised protocol.

Methods
The study was carried out in an outpatient setting in 103 patients suffering from bilateral Raynaud's phenomenon without any obvious underlying disease and who were unresponsive to nifedipine and aspirin.
All patients had angiographies taken according to a standardized technique using vasodilatating medication, and reviewed according to a standardised protocol that covered all the known characteristics of angiopathy such as diminished flow, stops, tortuosity, irregularity of the wall, tapering, collaterals and blushing.

Results
Standardised angiograms showed vasculopathy compatible with primary vasospasm in 42 patients [all women; mean age 35.1 years], atherosclerotic vascular disease in 44 patients [M/F 9/35; mean age 46.7 years], peripheral embolism in 8 patients [M/F 4/4; mean age 38.4 years], vasculitis in 3 patients [3 women; mean age 38 years] and Buerger's disease in 3 patients [3 men; mean age 47 years]. Inter-observer differences were present in 4 cases, but consensus could be reached through open discussion. An unexpected 47% of patients with atherosclerotic vascular disease had dyslipidemia, frequently of familial origin.

Conclusions
The standardised angiography protocol proved to be helpful in the assessment of upper extremity angiography. Surprisingly, a high prevalence of angiographic abnormalities compatible with atherosclerotic vascular disease could already be diagnosed in relatively young patients with Raynaud's phenomenon, of whom 47% showed hypercholesterolemia.

Key words
Raynaud's phenomenon, hand angiography, classification angiopathy, hypercholesterolemia.

Please address correspondence to: Richard M. van Vugt, Department of Rheumatology and Clinical Immunology, Slotervaart Hospital, P.O. Box 90440,
1006 BK Amsterdam, The Netherlands.