Cannabis Arteritis Revisited

Abstract

The purpose of this paper was to revisit the old concept of cannabis arteritis first described in the 1960s and report 10 new cases. Ten male patients, with a median age of 23.7 years developed subacute distal ischemia of lower or upper limbs, leading to necrosis in the toes and/or fingers and sometimes to distal limb gangrene. Two of the patients also presented with venous thrombosis and three patients were suffering from a recent Raynaud's phenomenon. Biological test results did not show evidence of the classical vascular risk factors for thrombosis. Arteriographic evaluation in all cases revealed distal abnormalities in the arteries of feet, legs, forearms, and hands resembling those of Buerger's disease. A collateral circulation sometimes with opacification of the vasa nervorum was noted. In some cases, arterial proximal atherosclerotic lesions and venous thrombosis were observed. All patients were moderate tobacco smokers and regular cannabis users. Despite treatment with ilomedine and heparin in all cases, five amputations were necessary in four patients. The vasoconstrictor effect of cannabis on the vascular system has been known for a long time. It has been shown that delta-8- and delta-9-tetrahydrocanabinols may induce peripheral vasoconstrictor activity. Cannabis arteritis resembles Buerger's disease, but patients were moderate tobacco smokers and regular cannabis users. These cases show that prolonged use of cannabis could be an additive risk factor for juvenile and young adult arteritis. Cannabis arteritis is a forgotten and severe occlusive vascular disease occurring in young adults. Search for cannabis use may be an important tool for a better knowledge of arteritis in young smokers.

Safety Issues Concerning the Medical Use of Cannabis and Cannabinoids

“…It is not clear whether the use of cannabis was causally related to AIDS-related mortality or whether cannabis smoking was used to treat worsening symptoms and was a confounder in this analysis. Vascular effects: Peripheral arteritis, which is analogous to Buerger's disease in tobacco smokers, has been reported in several case reports (109,110).…”

Vascular effects of cannabis: Case report and review of literature

“…In Disdier's review of ten patients, three were noted to have slightly elevated homocysteine levels, though the levels were not specified. Most patients did not have other cardiovascular risk factors [11]. In Peyrot's review of 55 patients, hypercholesterolemia was documented once and there were 4 cases of hypertriglyceridemia and one case of diabetes [7], though this was not observed in our patient.…”

“…However, this histopathology analysis was made in late lesions and the author did not specify how many biopsies they found [13]. On the other hand, Disdier has reported thrombosis and endarteritis associated with mild inflammation involving the media, with fragmentation of the internal elastic lamina [11].…”

Evaluation of thromboprophylaxis in medium-sized general hospital

“…9 Important centers in America and Europe dedicated themselves to studying the clinical and surgical risk factors and to establishing international prophylaxis protocols that would guide and unify actions taken to avoid DVT and PTE cases. 9,10 In Brazil, a number of entities, such as the Federal Medical Council (Conselho Federal de Medicina), be pointed out that these guidelines only deal with DVT in lower extremities and define them either as proximal, when the iliac, femoral and/or popliteal veins are involved, irrespective or thrombosis in leg veins, or distal, when only veins of the leg are involved.…”