Arteriospastic Disorders of the Extremities

THERE is a relatively uncommon group of conditions that cause intermittent or permanent ishebmia of the extremities due to spasm of tiny arteries and arterioles without structural occlusion of their lumens. These "arteriospastic disorders" include Raynaud 's phenomenon, livedo reticularis, and acrocyanosis (table 1). Much confusion exists regarding the diagnosis of these conditions, not only because of inconsistent terminology in the literature, but also because the first two conditions may occur as primary disease entities or they may be symptoms of other and often mnore serious diseases (table 2). Further confusion arises because, although arteriospastic disorders produce isehemia in the absence of organie occlusive disease, they can occur as symptoms of associated chronic or acute occlusive arterial disease, and prolonged arterial spasm can, in some cases, lead to organic occlusive changes. Unlike the organic occlusive arterial diseases usually affecting major arterial trunks, the arteriospastic disorders involve tiny arteries and arterioles supplying the skin of the hands and feet, and, in the case of livedo reticularis, the extremities and trunk as well. The clinical manifestations, then, are primarily changes in color and temperature of the skin. Occasionally, ulcerations occur when isehemic skin breaks down. Since ischemia is confined to the skin, intermittent claudication and extensive gangrene requiring major amputation do not occur as a result of these arteriospastic disorders uniless there is associated organic occlusive disease of larger arteries (table 3). Patients with arteriospastic disorders are frequently young women who are nervous, easily fatigued, emotionally labile, and often unmarried. In addition to the typical color