SURGICAL MANAGEMENT OF VASCULAR LESIONS IN PATIENTS WITH SCLERODERMA: APPROACH IN VASCULAR SURGERY AND RHEUMATOLOGY

Abstract

Introduction: Surgical management of vascular lesions in patients with scleroderma presents significant challenges due to the complex nature of this autoimmune condition, which affects the skin and blood vessels, resulting in vascular alterations that can lead to serious complications. Scleroderma causes alterations in the microcirculation, predisposing patients to digital ulcers, pulmonary hypertension, and other vascular manifestations that often require surgical intervention. Collaboration between specialists in vascular surgery and rheumatology is crucial to optimize care and interventions in patients facing these complications. Objective: To examine the literature on the surgical management of vascular lesions in patients with scleroderma, emphasizing the practices of vascular surgery and rheumatology. Methodology: The methodology was conducted following the PRISMA checklist, using the PubMed, SciELO, and Web of Science databases. Five descriptors were used: "scleroderma", "vascular lesions", "vascular surgery", "treatment", and "rheumatology". Inclusion criteria were: peer-reviewed articles, studies conducted in the last ten years, and studies that addressed surgical interventions in patients with scleroderma. Exclusion criteria included articles not available in English or Portuguese, studies with samples of fewer than ten patients, and non-original reviews. Results: The results revealed that the surgical approach can be effective, but is often accompanied by complications, including infections and difficulties in healing. The literature emphasized the importance of careful evaluation and personalized treatments, in addition to the need for continuous monitoring of vascular manifestations. Different types of interventions, such as grafts and debridements, were also discussed, which have been shown to vary in effectiveness depending on the patient profile. Conclusion: The review highlighted that the surgical management of vascular lesions in patients with scleroderma requires a multidisciplinary approach and careful planning. Interventions can bring significant benefits, but the risk of complications must be considered. The integration of the specialties of vascular surgery and rheumatology is essential to improve clinical outcomes and quality of life of these patients.