Arthritis Q&A by Dr. Shiel

Answer:

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For patients with severe Raynaud's phenomenon (RP) that is not responding to medications, surgical treatment is considered. The nerves that are responsible for stimulating the muscles in the walls of the blood vessels to contract and aggravate RP are part of the sympathetic nervous system.

Interruption of the nerves of the sympathetic nervous system is called a sympathectomy. Sympathectomy can be performed by interrupting the nerves in the neck for RP of the hands or in the low back (lumbar) area for RP of the feet. Currently, the preferred method of sympathectomy is a localized procedure in the hand or foot. Before performing a local digital sympathectomy, the surgeon "blocks" the sympathetic nerves with an anesthetic to determine whether or not interruption of these nerves surgically will have benefit by decreasing the RP.

Finally, occasionally severe RP is aggravated by underlying blood vessel disease that can be repaired surgically by operations that restore blood flow through clogged vessels.

Thank you for your question.