Integrative management of microvascular spasm-driven Raynaud's-like digital ischemia in an elderly smoker with mixed-pattern vasculopathy: A case report.

BACKGROUND: Chronic smoking is a key driver of endothelial dysfunction and microcirculatory impairment, contributing to "mixed-pattern vasculopathy," a condition characterized by coexisting macrovascular stenosis and microvascular tone dysregulation. This pathology significantly increases the risk of refractory distal ulceration, dry gangrene, and amputation. This case report aimed to describe the clinical course and therapeutic outcome of integrative treatment with Chinese herbal medicine (CHM) in a patient with refractory ischemia associated with mixed-pattern vasculopathy.

CASE PRESENTATION: An 80-year-old man with a 100-pack-year smoking history presented with Raynaud's-like digital ischemia, including severe pain, cyanosis, and skin ulceration. Diagnostic imaging revealed multifocal atherosclerotic stenoses of the lower extremity arteries, emphysematous lung changes, cerebral small-vessel disease, and mild heart myocardial perfusion abnormalities. Although percutaneous transluminal angioplasty was performed, only partial revascularization was achieved because of unfavorable vascular architecture, and distal perfusion remained inadequate, with persistent cyanosis and pain. Integrative treatment with CHM, aimed at improving vascular circulation, was subsequently initiated. The intervention resulted in rapid pain reduction, improved peripheral skin perfusion, and complete healing of ulcers within 1 year. No recurrence of ischemic symptoms was observed during >2 years of follow-up.

CONCLUSION: This case report suggests that integrative CHM may serve as a clinically meaningful adjunctive therapy for microvascular-predominant ischemia, particularly when conventional revascularization and standard vasodilator therapies fail to achieve adequate symptom control in patients with mixed-pattern vasculopathy.