Raynaud's phenomenon, digital ulcers and critical digital ischaemia
Raynaud's phenomenon, digital ulcers and critical digital ischaemia
Raynaud's phenomenon, digital ulcers and critical digital ischaemia
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Management of Critical Digital Ischaemia<br />
1.<br />
Establish diagnosis <strong>and</strong> identify any treatable<br />
contributory cause<br />
No contributory cause<br />
2.<br />
Treat any contributory cause<br />
- Large (proximal) vessel disease<br />
-Vasculitis<br />
-Coagulopathy<br />
-Thromboembolism<br />
- Smoking<br />
3. 4. 5.<br />
Admit for IV<br />
Antiplatelet therapy Consider statin 6.<br />
+ +<br />
prostanoid <strong>and</strong><br />
+<br />
analgesia<br />
Antibiotic if any<br />
possibility of infection<br />
Ineffective<br />
Effective<br />
7.<br />
Optimise oral vasodilator therapy<br />
(consider PDE5 inhibitor)<br />
8. Consider <strong>digital</strong><br />
9. Surgical debridement if necrotic<br />
10.<br />
sympathectomy + tissue<br />
+<br />
Short term anticoagulation
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