{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:01:28Z","timestamp":1780473688741,"version":"3.54.1"},"reference-count":30,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Objectives: Systemic sclerosis (SSc) is a disease characterized by diffuse sclerosis of skin and organs and small vessel vasculopathy. Despite it, large vessels can also be involved with ulnar artery vasculopathy, revealing as a more frequent feature of SSc. The aim of this paper is to assess the macrovascular involvement of SSc patients through an ultrasound (US) evaluation of radial and ulnar arteries. Methods: Radial and ulnar resistance indices (RIs) and peak systolic velocity (PV) (cm\/s) together with clinical features of SSc patients were evaluated. Raynaud phenomenon (RP) and healthy control (HC) groups were used for comparison. Results: Forty-three SSc patients were evaluated. Twelve patients (28%) had ulnar artery occlusions (UAOs). In nine cases (75%), UAOs were bilateral. A high UAO prevalence (42%) was found in SSc patients with late nailfold-video-capillaroscopy (NVC) pattern (p = 0.0264). Patients with UAOs had digital ulcers (DUs) in 10 cases (83.3%). Radial and ulnar PVs were lower in SSc and RP patients than the HC group. Radial and ulnar RIs were higher in SSc and RP patients than the HC group. A decision tree analysis led to the classification of 70% of SSc patients with an ulnar RI &gt; 0.82 and ulnar PV &gt; 2.8 cm\/s. The most influential variables on UAO development were interstitial lung disease (ILD) (p = 0.002) and NVC pattern (p = 0.002). A positive correlation was shown between modified Rodnan skin score (mRSS) and ILD (p = 0.283; r = 0.033), mRSS and DU (r = 0.344; p = 0.012) and DU and ILD (r = 0.303; p = 0.024). Male sex was associated with increased UAO frequency (p = 0.042). Conclusions: UAO is a peculiar feature of severe SSc present in 28% of the cases, particularly associated with the presence of ILD and late NVC pattern. In 75% of the cases, UAOs are bilateral. DUs are very frequent in patients with UAOs (83%). The RI evaluated by US could be useful to distinguish SSc from HC patients. US could be a useful tool for assessing high-risk DU development in patients.<\/jats:p>","DOI":"10.3390\/life13020487","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T03:52:49Z","timestamp":1676001169000},"page":"487","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Peripheral Macrovascular Involvement in Systemic Sclerosis: A Cohort Study by Color and Spectral Doppler Ultrasonography"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8350-7581","authenticated-orcid":false,"given":"Roberto","family":"D\u2019Alessandro","sequence":"first","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estrella","family":"Garcia Gonzalez","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2667-4866","authenticated-orcid":false,"given":"Paolo","family":"Falsetti","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3974-6606","authenticated-orcid":false,"given":"Edoardo","family":"Conticini","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2368-5722","authenticated-orcid":false,"given":"Miriana","family":"d\u2019Alessandro","sequence":"additional","affiliation":[{"name":"Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Selvi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Bellisai","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Berlengiero","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Vallifuoco","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Paola","family":"Pata","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bardelli","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Baldi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-1275","authenticated-orcid":false,"given":"Luca","family":"Cantarini","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8351-3703","authenticated-orcid":false,"given":"Elena","family":"Bargagli","sequence":"additional","affiliation":[{"name":"Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Frediani","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e000782","DOI":"10.1136\/rmdopen-2018-000782","article-title":"Systemic sclerosis: State of the art on clinical practice guidelines","volume":"4","author":"Smith","year":"2018","journal-title":"RMD Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1136\/annrheumdis-2015-208857","article-title":"Reliability of the quantitative assessment of peripheral blood perfusion by laser speckle contrast analysis in a systemic sclerosis cohort","volume":"75","author":"Lambrecht","year":"2016","journal-title":"Ann. Rheum. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"104087","DOI":"10.1016\/j.lpm.2021.104087","article-title":"Pathophysiology of systemic sclerosis","volume":"50","author":"Thoreau","year":"2021","journal-title":"La Presse M\u00e9dicale"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1002\/acr.22965","article-title":"Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study","volume":"69","author":"Lescoat","year":"2017","journal-title":"Arthritis Care Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1002\/art.40799","article-title":"Ulnar Artery Occlusion and Severity Markers of Vasculopathy in Systemic Sclerosis: A Multicenter Cross-Sectional Study","volume":"71","author":"Lescoat","year":"2018","journal-title":"Arthritis Rheumatol."},{"key":"ref_6","first-page":"102","article-title":"Ulnar artery involvement in systemic sclerosis (scleroderma)","volume":"29","author":"Taylor","year":"2002","journal-title":"J. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Romano, E., Rosa, I., Fioretto, B.S., Matucci-Cerinic, M., and Manetti, M. (2022). Increased Circulating Soluble Junctional Adhesion Molecules in Systemic Sclerosis: Association with Peripheral Microvascular Impairment. Life, 12.","DOI":"10.3390\/life12111790"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"104064","DOI":"10.1016\/j.lpm.2021.104064","article-title":"Digital Ulcers in Systemic Sclerosis","volume":"50","author":"Hughes","year":"2021","journal-title":"Presse Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Frech, T.M., Frech, M., Saknite, I., O\u2019Connell, K.A., Ghosh, S., Baba, J., and Tkaczyk, E.R. (2023). Novel therapies and innovation for systemic sclerosis skin ulceration. Best Pract. Res. Clin. Rheumatol., 101813.","DOI":"10.1016\/j.berh.2022.101813"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1038\/s41584-020-0386-4","article-title":"Raynaud phenomenon and digital ulcers in systemic sclerosis","volume":"16","author":"Hughes","year":"2020","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1136\/annrheumdis-2013-204424","article-title":"2013 classification criteria for systemic sclerosis: An American college of rheumatol-ogy\/European league against rheumatism collaborative initiative","volume":"72","author":"Khanna","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejim.2022.01.026","article-title":"Ultrasound evaluation of bowel vasculopathy in systemic sclerosis","volume":"100","author":"Bandini","year":"2022","journal-title":"Eur. J. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.amjms.2022.02.014","article-title":"Assessment of kidney involvement in systemic sclerosis: From scleroderma renal crisis to subclinical renal vasculopathy","volume":"364","author":"Gigante","year":"2022","journal-title":"Am. J. Med. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5509","DOI":"10.1093\/rheumatology\/keab278","article-title":"ANCA in systemic sclerosis, when vasculitis overlaps with vasculopathy: A devastating combination of pathologies","volume":"60","author":"Hughes","year":"2021","journal-title":"Rheumatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1136\/ard.2003.009118","article-title":"Doppler ultrasound identifies increased resistive indices in SSc","volume":"63","author":"Bregenzer","year":"2004","journal-title":"Ann. Rheum. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s10067-009-1131-1","article-title":"Dynamic Doppler evaluation of the hand arteries of the patients with Raynaud\u2019s disease","volume":"28","author":"Toprak","year":"2009","journal-title":"Clin. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.2214\/ajr.172.6.10350298","article-title":"Doppler spectral waveform analysis of arteries of the hand in patients with Raynaud\u2019s phenomenon as compared with healthy subjects","volume":"172","author":"Chikui","year":"1999","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.mvr.2011.07.009","article-title":"In systemic sclerosis macrovascular damage of hands digital arteries correlates with microvascular damage","volume":"82","author":"Rosato","year":"2011","journal-title":"Microvasc. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"104210","DOI":"10.1016\/j.mvr.2021.104210","article-title":"Color Doppler Ultrasonography of digital arteries and digital ulcers development in systemic sclerosis","volume":"138","author":"Colalillo","year":"2021","journal-title":"Microvasc. Res."},{"key":"ref_20","first-page":"1591","article-title":"Color Doppler ultrasonography of hand and finger arteries to differentiate primary from secondary forms of Raynaud\u2019s phenomenon","volume":"35","author":"Schmidt","year":"2008","journal-title":"J. Rheumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1111\/j.1365-2044.2012.07235.x","article-title":"Evaluation of radial and ulnar blood flow after radial artery cannulationwith 20- and 22-gauge cannulae using duplex Doppler ultrasound","volume":"67","author":"Kim","year":"2012","journal-title":"Anaesthesia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1213\/ANE.0b013e3181bbd416","article-title":"Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations","volume":"109","author":"Brzezinski","year":"2009","journal-title":"Anesth. Analg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.mvr.2018.07.001","article-title":"Evidence of macro- and micro-angiopathy in scleroderma: An integrated approach combining 22-MHz power Doppler ultrasonography and video-capillaroscopy","volume":"122","author":"Schioppo","year":"2018","journal-title":"Microvasc. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.semarthrit.2016.05.001","article-title":"Differential diagnosis of critical digital ischemia in systemic sclerosis: Report of five cases and review of the literature","volume":"46","author":"Sharp","year":"2016","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1093\/rheumatology\/kex045","article-title":"Detection of severe digital vascu- lopathy in systemic sclerosis by colour Doppler sonography is associated with digital ulcers","volume":"56","author":"Friedrich","year":"2017","journal-title":"Rheumatology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s13075-020-02235-7","article-title":"The first composite score predicting Digital Ulcers in systemic sclerosis patients using Clinical data, Imaging and Patient history\u2014CIP-DUS","volume":"22","author":"Friedrich","year":"2020","journal-title":"Arthritis Res. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s13075-019-1867-1","article-title":"Survival and prognosis factors in systemic sclerosis: Data of a French multicenter cohort, systematic review, and meta-analysis of the literature","volume":"21","author":"Pokeerbux","year":"2019","journal-title":"Arthritis Res. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ecl.2017.10.010","article-title":"Pathogenesis of Cardiovascular Disease in Diabetes","volume":"47","author":"Haas","year":"2018","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1093\/rheumatology\/ker414","article-title":"Ulnar artery occlusion is predictive of digital ulcers in SSc: A duplex sonography study","volume":"51","author":"Frerix","year":"2011","journal-title":"Rheumatology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"SI91","DOI":"10.1093\/rheumatology\/keac405","article-title":"Use of platelet inhibitors for digital ulcers related to systemic sclerosis: EUSTAR study on derivation and validation of the DU-VASC model","volume":"62","author":"Garaiman","year":"2022","journal-title":"Rheumatology"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/2\/487\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:29:54Z","timestamp":1760120994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/2\/487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,10]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["life13020487"],"URL":"https:\/\/doi.org\/10.3390\/life13020487","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,10]]}}}