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Published on: September 22, 2020
Catheter angiography and angioplasty in patients with scleroderma
1Department of Radiology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Insights
Scleroderma patients often have distal upper limb disease. Lower limb angioplasty may benefit scleroderma patients with additional vascular risk factors, but results vary.
Area of Science:
- Vascular Medicine
- Rheumatology
- Radiology
Background:
- Scleroderma is a connective tissue disease that can cause significant vascular complications.
- Understanding angiographic disease patterns in scleroderma is crucial for effective treatment planning.
Purpose of the Study:
- To identify angiographic disease patterns in scleroderma patients, with and without other vascular risk factors.
- To determine the utility of angiography and angioplasty in managing scleroderma-related vascular disease.
Main Methods:
- Review of 26 scleroderma patients who underwent angiography and angioplasty over 8 years.
- Assessment of angiographic disease patterns using a modified Brewster classification.
- Correlation of disease patterns with the presence or absence of vascular risk factors.
Main Results:
- Upper limb angiography revealed distal disease in 86% of patients, irrespective of other vascular risk factors.
- Lower limb angiography showed an association between vascular risk factors and macrovascular disease amenable to angioplasty.
- Lower limb angiography showed an association between the absence of vascular risk factors and distal disease.
- Angioplasty yielded good early but poor late clinical results in 3 of 5 patients.
Conclusions:
- Upper limb angiography in scleroderma typically shows distal disease.
- Lower limb angiography and angioplasty may be beneficial for scleroderma patients with co-existing vascular risk factors.
Abstract:
The objectives of this study were (i) to identify patterns of angiographic disease in scleroderma patients with and without other vascular risk factors and (ii) to define patients with scleroderma in whom angiography and angioplasty is useful. The records of 26 patients with scleroderma who underwent angiography and angioplasty over an 8-year period were reviewed. Angiographic disease patterns were assessed using a modified Brewster classification. Angiography of the upper limb demonstrated distal disease alone in 86% of patients, both with and without other vascular risk factors such as smoking. In the lower limb there was a highly significant association between the presence of other vascular risk factors and macrovascular disease potentially amenable to angioplasty, and conversely between the absence of other vascular risk factors and distal disease in the lower limb. Good early but poor late clinical results were achieved in three of five patients who underwent angioplasty. Angiography of the upper limb is likely to demonstrate distal disease alone, and angiography and angioplasty of the lower limb may be useful only if other vascular risk factors are present.
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