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Involvement of peripheral arteries in giant cell arteritis: a color Doppler sonography study
W A Schmidt1, A Natusch, D E Möller
1Medical Center for Rheumatology Berlin-Buch, Berlin, Germany. schmidt.wa@t-online.de
Insights
Giant cell arteritis (GCA) can affect arteries beyond the temporal arteries, impacting peripheral circulation. Color Doppler sonography effectively detects this peripheral artery involvement in GCA patients.
Area of Science:
- Vascular Medicine
- Rheumatology
- Diagnostic Imaging
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium-sized arteries.
- Temporal artery biopsy is the gold standard for diagnosis, but it has limitations and may not detect all affected vessels.
Purpose of the Study:
- To investigate the involvement of arteries beyond the temporal arteries in active GCA.
- To assess the utility of color Doppler sonography in detecting peripheral arterial involvement in GCA.
Main Methods:
- Color Doppler sonography was used to examine multiple arteries (occipital, facial, vertebral, carotid, subclavian, axillary, brachial, ulnar, radial, femoral, popliteal, posterior tibial, dorsal pedal, and abdominal aorta).
- 33 consecutive patients with acute GCA and 33 age- and sex-matched controls were included.
Main Results:
- Inflammatory mural thickening (halo) was observed in 30% of GCA patients, but none of the controls.
- Peripheral arteries such as subclavian, external carotid, facial, occipital, axillary, brachial, and ulnar arteries showed involvement.
- Occlusions were found in the ulnar, posterior tibial, dorsal pedal, and vertebral arteries of GCA patients, unlike controls.
Conclusions:
- Peripheral artery involvement is more common in acute GCA than previously thought.
- Color Doppler sonography is a valuable non-invasive tool for evaluating peripheral arterial involvement in GCA.
Objective:
To investigate the involvement of arteries other than the temporal arteries in active giant cell arteritis using color Doppler sonography.
Methods:
The occipital, facial, vertebral, carotid, subclavian, axillary, brachial, ulnar radial, femoral, popliteal, posterior tibial, and dorsal pedal arteries, and the abdominal aorta of 33 consecutive patients with acute giant cell arteritis and 33 age- and sex-matched controls were investigated.
Results:
In 10 patients (30%), but in none of the controls, a characteristic inflammatory mural thickening (halo) could be demonstrated in these arteries. The subclavian, external carotid, and/or facial arteries were involved in 4 patients, the occipital and/or axillary arteries in 3 patients, the brachial and/or ulnar arteries in 2 patients, and the common carotid, vertebral, popliteal, and/or radial arteries in 1 patient each. Two patients had symptomatic large vessel giant cell arteritis with arm claudication. The other patients were asymptomatic concerning the involved arteries. Furthermore the ulnar artery was occluded in 3 cases, the posterior tibial artery in 2 cases, and the dorsal pedal and the vertebral artery in 1 case each. No occlusions were found in the controls. Occlusion of the temporal arteries occurred more frequently in patients with peripheral artery involvement than in those without peripheral involvement (60% versus 26%). In most of the non-stenotic, small arteries the halo disappeared within 9 to 21 days. Mural thickening remained in large, stenotic arteries.
Conclusion:
Peripheral artery involvement occurs more frequently in acute temporal arteritis than has been assumed up to now. Color Doppler sonography offers a new method to evaluate this peripheral involvement.
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