When do you consider vascular imaging in patients with Raynaud's and what type of imaging modalities do you utilize?

I typically do not do any vascular imaging studies on patients with Raynaud phenomenon if they have typical symptoms. I do perform nailfold capillaroscopy in patients with new-onset Raynaud to help determine the presence of or risk for future development of connective tissue disease. Studies suggest that 12% of patients who present with Raynaud will go on to develop CTD. Abnormal nailfold capillaries increase the risk (along with the presence of autoantibodies) [Ref: Koenig et al., PMID 19035499]. If the patient has scleroderma and they have severe ulcers, I will often image the macrovasculature to look for occlusive ulnar artery disease which could possibly be amenable to intervention. I typically do this with arterial dopplers. If someone...