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Arterial vasculopathy in systemic sclerosis: computerized tomography (CT) angiographic features of macrovascular and
Yasser Emad1, Hend Al-Sherbeni2, Yasser Ragab3
1Rheumatology and Rehabilitation Department, Faculty of medicine Cairo University, Cairo, Egypt; Rheumatology and Rehabilitation Department, Faculty of medicine, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia.
Insights
Systemic sclerosis (SSc) can cause arterial vasculopathy in upper limb major, medium, and micro vessels, regardless of disease type or digital ulcer presence. This finding highlights the widespread vascular impact of SSc.
Area of Science:
- Vascular Medicine
- Rheumatology
- Radiology
Background:
- Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis, vascular dysfunction, and immune dysregulation.
- Arterial vasculopathy, affecting vessels of all sizes, is a known complication in SSc, potentially leading to digital ulcers and other ischemic complications.
Purpose of the Study:
- To detail the computed tomography angiography (CTA) findings of arterial vasculopathy in the entire upper limb arterial tree of patients with SSc.
- To investigate potential differences in vascular involvement between SSc patients with and without digital ulceration.
Main Methods:
- Twenty-two SSc patients (12 limited, 10 diffuse) meeting ACR criteria underwent CTA of both upper limbs.
- Routine laboratory investigations, including lipid profiles, were performed for all participants.
Main Results:
- CTA revealed vasculopathy in subclavian (3), axillary (5), brachial (5), radial (4), and ulnar (5) arteries.
- Superficial palmar arch non-visualization occurred in 2 patients; 18 showed vessel wall thinning and poor distal runoff.
- Increased arterial vasculopathy correlated significantly with elevated systolic pulmonary artery pressure (P=0.001).
Conclusions:
- Macrovascular arterial vasculopathy affects the upper limbs in SSc, independent of disease subtype.
- Major, medium, and microvascular arteries in the upper limbs are susceptible to involvement in SSc.
Objective:
To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration.
Methods:
Twenty-two cases with systemic sclerosis (12 limited and 10 diffuse) were recruited for the study. All patients fulfilled the American Rheumatism Association (ACR) criteria for the classification of SSc. For all patients routine laboratory investigations were performed including complete lipid profile. Computed tomography angiography (CTA) studies for the whole upper limb arterial tree were performed for both upper limbs in all cases.
Results:
CTA studies showed involvement of subclavian arteries in 3 cases and axillary artery was involved in five cases. Brachial artery was affected in 5 cases. In the forearm the radial artery was affected in 4 cases with bilateral involvement in two cases (6 vessels), while ulnar artery was affected in five cases. Unilateral non visualization of the superficial palmar arch was observed in two cases with limited disease, while thinning out of the vessel wall with poor distal run off in 18 cases. A higher number of arterial vasculopathy was significantly associated with systolic pulmonary artery pressure (P=0.001).
Conclusions:
Macrovascular arterial vasculopathy of upper limbs may occur in SSc irrespective of the disease pattern. Major arteries can be affected in association with other medium sized arteries of the forearms and microvascular arterial branches of the hands.
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