Giant cell arteritis as unusual cause of critical arm ischemia

Abstract

Giant cell arteritis is an inflammatory vasculopathy of unknown etiology that typically affects the carotid artery and its branches. Symptomatic involvement of upper extremity arteries is uncommon. We report a case of a 70-year-old woman with polymyalgia rheumatica who presented with critical arm ischemia, constitutional symptoms, and elevated erythrocyte sedimentation rate. Urgent revascularization by a carotid-brachial artery bypass was performed. Histopathologic evaluation of a specimen obtained intraoperatively from the occluded axillary artery confirmed the diagnosis, and corticosteroid therapy was initiated. Large-vessel vasculitis should be considered a rare differential diagnosis in occlusive disease of the upper extremity.

Critical arm ischemia as rare presentation of giant cell arteritis

“… 9 Surgical revascularization is, therefore, rare, and only a very few cases of revascularization have been reported in which the patients had presented with critical arm ischemia requiring carotid–brachial artery bypass, as was the case for our patient. 4 , 5 , 10 Also, even when significant stenosis of the arteries is discovered, the distal tissue viability will rarely be compromised, even when ischemic symptoms, such as the loss of pulses, are present, because the gradual development of arterial narrowing will have allowed for the establishment of extensive collateral circulation. 11 …”

“…However, for surgical revascularization, the long-term results are largely unknown, with the longest reported follow-up at 6 months. 10 We also believed that initiating steroids would probably help control the inflammatory process and would subsequently allow us to perform the anastomosis in segments of the arteries that were free of “visual” disease (ie, when the disease was in its quiescent phase), 11 which could help increase the long-term patency of the bypass.…”

Four common diseases causing sudden blindness or death in the eye emergency department

“…10 23 Symptoms duration is usually less than 1 or 2 hours but longer episodes can sometimes occur. 17 Transient monocular vision loss (TMVL) due to vascular causes is considered a retinal TIA. Acute retinal arterial ischaemia includes TMVL, BRAO and CRAO.…”

Giant cell arteritis: is the clinical spectrum of the disease changing?

“…On physical examination, it is important to look for abnormalities in temporal arteries (i.e. thickening, tenderness, beading or reduced pulsation) [20, 21], but attention must also be focused on the remaining peripheral arterial territories to disclose pulse deficits, bruits or asymmetric arterial pressure measurements in any of the four limbs [22]. Although there is no specific laboratory marker for the disease, acute phase reactants (platelets, erythrocyte sedimentation rate and/or C reactive protein) are elevated in the majority of patients [23].…”