Long-Term Follow-Up of Upper and Lower Extremity Vasculitis Related to Giant Cell Arteritis

Assié, C.; Janvresse, A.; Plissonnier, Didier; Lévesque, H.; Marie, I.

doi:10.1097/md.0b013e318206af16

Cited by 90 publications

(62 citation statements)

References 82 publications

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“…In contrast to atherosclerotic etiology, ischemic symptoms in patients with GCA progressed rapidly and lead to development of limb-threatening ischemia within very short of time (15). Assie and his colleagues came up with similar results demonstrating a common presence of upper and lower extremity involvement in GCA even in early phase of disease (16). According to published cases prognosis of limb involvement is quite variable, patients with critical limb ischemia frequently undergo revascularisation treatment.…”

Section: Giant-cell Arteritissupporting

confidence: 60%

Vasculitides as a rare cause of intermittent claudication

Celecova¹,

Krahulec²,

D³

et al. 2013

BLL

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Intermittent claudication of the lower extremities is a common symptom described in older patients with atherosclerotic peripheral arterial disease. Peripheral arterial disease due to atherosclerosis is known to be associated with a higher risk of myocardial infarction, stroke and all-cause mortality. However, if intermittent claudication appears in a younger group of patients or older patients in absence of traditional risk factors for atherosclerosis such as smoking, dyslipidemia, arterial hypertension and diabetes mellitus other causes than atherosclerosis must be considered. These conditions include vasculitides, fi bromuscular dysplasia, cystic adventitial disease, excentric vascular compression by tumor, popliteal artery entrapment syndrome, trauma or dissection. Vasculitides present a heterogenous group of disorders characterized by infl ammatory destruction of blood vessels. Although often not a leading symptom intermittent claudication could be a part of a clinical picture in giant-cell arteritis, Takayasu´s arteritis, Buerger´s disease, polyarteritis nodosa or Behçet disease. Limb claudication is usually of rapid onset, progressive and bilateral. Each of the mentioned vasculitides is specifi c in ethiology and clinical manifestation with a variable prognosis for the patient. Increased awareness of the presence of different causes of limb claudication and their early diagnosis with a prompt initiation of appropriate treatment may help to avoid clinical progression that can lead to vascular surgery or even limb loss (Ref. 37). Full Text in PDF www.elis.sk.

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Section: Giant-cell Arteritissupporting

confidence: 60%

Vasculitides as a rare cause of intermittent claudication

Celecova¹,

Krahulec²,

D³

et al. 2013

BLL

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“…6 Assie et al also observed a lower rate of positive temporal artery biopsy in patients with temporal artery GCA compared to those with involvement of upper and lower limb arteries (69% vs. 95%). 7 Biopsy of the affected artery is generally only available if revascularization procedures take place, so the diagnosis and treatment strategy of large-vessel GCA are frequently decided before histological results are available. The biopsy may reveal transmural inflammatory infiltrate with fragmentation of the elastic lamina with or without giant cells in a focal and segmental distribution.…”

Section: Discussionmentioning

confidence: 99%

Acute upper limb ischemia, a rare presentation of giant cell arteritis

Almeida-Morais

Galego

Pack

et al. 2016

Revista Portuguesa de Cardiologia (English Edition)

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Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10---15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis.We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure.The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers.GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization. 2174-2049Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 237.e2L. Almeida-Morais et al. PALAVRAS-CHAVEArterite de células gigantes; Isquemia crítica dos membros superiores; Bypass carótido-umeral Isquemia crítica dos membros superiores, uma apresentação rara de arterite de células gigantes Resumo A arterite de células gigantes (ACG) é uma vasculite de grandes vasos, com envolvimento extracraniano em 10-15% dos casos, afetando preferencialmente a aorta e os seus ramos. Os aneurismas da aorta ascendente são mais frequentes em doentes com ACG, mas são raros no momento do diagnóstico.Apresentamos o caso de uma doente, caucasiana, com 80 anos de idade, que descrevia dor muscular nos membros superiores, com rigidez matinal dos ombros, desde há oito meses. Nos últimos dois meses referia claudicação intermitente de agravamento progressivo, dor intensa, extremidades frias e o aparecimento de úlceras digitais. Ao exame objetivo não se palpavam pulsos radiais ou cubitais, nem se registavam valores de pressão arterial.Laboratorialmente, destacava-se anemia normocíticanormocrómica, VS de 120 mm/h e ...

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“…Reconstructive study was performed in 10 patients. Histology of the vessels was obtained only in the 2 patients who underwent limb amputation; histologic analyses of vessel tissues showed damage consistent with active GCA [8] . Recently, some reports have suggested that TA and GCA are the same disease, because the histopathologic features are indistinguishable [9] .…”

Section: Discussionmentioning

confidence: 99%

“…Assie et al reported that all patients with extremity vasculitis related to GCA were given steroid therapy at a median daily dose of 1 mg/kg predonisolone initially and immunosuppressive drugs (MTX, azathioprine, or cyclophosphamide) were added in some patients [8] . In the present case, we initiated high-dose oral prednisolone (1 mg/kg/day) and then added MTX.…”

mentioning

confidence: 99%

A case of atypical Takayasu arteritis initially presenting with peripheral artery disease

Kawano

Hashimoto

Yoshijima

et al. 2014

CRCP

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A 28-year-old woman developed Raynaud's phenomenon and sudden left visual loss due to hypertensive retinopathy. One and a half years later, she noticed peripheral coldness and numbness of right foot. Enhanced computed tomography showed remarkable stenosis of left radial and bilateral tibial arteries. Initially, the diagnosis of idiopathic peripheral arterial occlusive disease (PAD) was made. PAD gradually progressed despite the medication with antiplatelet drug and vasodilator, and coronary angiography revealed a left coronary artery aneurysm. Then, she developed the same ischemic symptom of right hand and left visual loss caused by papilledema. Although 18 F-fluorodeoxyglucose positron-emission tomography showed no abnormalities, and both HLA-B52 and HLA-B39 were negative, she was diagnosed with atypical Takayasu arteritis (TA) by exclusion of other possible diseases. To the best of our knowledge, this is the first case of TA with coronary aneurysm and PAD. In TA patients, the involvement of medium-sized vascular lesion such as peripheral extremity arteries should be considered.

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Long-Term Follow-Up of Upper and Lower Extremity Vasculitis Related to Giant Cell Arteritis

Cited by 90 publications

References 82 publications

Vasculitides as a rare cause of intermittent claudication

Vasculitides as a rare cause of intermittent claudication

Acute upper limb ischemia, a rare presentation of giant cell arteritis

A case of atypical Takayasu arteritis initially presenting with peripheral artery disease

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