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[Angiographic diagnosis in giant cell arteritis of the arm arteries]
V Mickley1, J M Friedrich, L Sunder-Plassmann
1Klinik für Gefäss-, Thorax- und Herzchirurgie, Universität Ulm.
Insights
Giant cell arteritis can cause chronic arm claudication due to arterial stenoses and occlusions. Arteriography reveals characteristic changes, aiding diagnosis even without biopsies.
Area of Science:
- Vascular Surgery
- Rheumatology
- Diagnostic Imaging
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium arteries.
- Arm involvement in GCA is less common but can lead to significant ischemic symptoms like claudication.
Observation:
- Three elderly female patients presented with chronic arm claudication.
- Symptoms were attributed to giant cell arteritic stenoses and occlusions of arm arteries.
Findings:
- Arteriography demonstrated progressive arterial changes: early smooth or undulatory long-segment narrowings, evolving into spindle-shaped filiform stenoses (unilateral, bilateral-symmetric, or beaded patterns).
- Untreated arteritis led to smoothly tapered occlusions of affected arm vessels.
Implications:
- Typical arteriographic findings in patients with suspected GCA can support the diagnosis.
- This imaging-based diagnosis is valuable when histopathological confirmation is challenging or unavailable.
Abstract:
Three women of 66, 68 and 69 years of age presented with chronic arm claudication caused by giant cell arteritic stenoses and occlusions of their arm arteries. In the early stage of the disease, arteriography revealed smooth or undulatory long-segment narrowings. Subsequently, spindle-shaped filiform stenoses developed. They were unilateral in one patient, bilateral-symmetric in another and like a string of beads in the third. In the end, untreated arteritis resulted in smoothly tapered occlusions of the diseased vessels. In patients with symptoms and signs suggestive of giant cell arteritis, typical arteriographic findings may confirm the diagnosis even if histopathological proof is lacking.