Distribution of macrovascular disease in scleroderma

Abstract

Objective-Macrovascular disease in scleroderma has recently been described in two comparative studies. The aim of this study was to map its anatomical distribution. Methods-In a retrospective cohort study of 20 scleroderma patients, the results of Doppler studies of arteries in the limbs, neck, and abdomen were compared with those from 20 cohort negative patients. The latter were matched for age, sex, and the presence/absence of hypertension, hyperlipidaemia, smoking, and diabetes status. Arteries were compared quantitatively using a body surface area adjusted measurement of intraluminal diameter, and qualitatively using descriptive characteristics of the arterial walls. The latter were binomially categorised under three non-exclusive headings-thickening, stenosis, and calcification. Results-The ulnar arteries in scleroderma patients were significantly narrower than those of the negative cohort. The arterial walls were also characterised by smooth thickening along their entire length. The characteristics of the other arteries, including those of the lower limbs, were not significantly diVerent from those of the negative cohort. Conclusion-The ulnar artery seems to be specifically targeted in patients with scleroderma. Assessment of the ulnar artery should be considered in these patients by means of a modified Allen's test or Doppler sonography especially in the presence of digital gangrene.

Estudo da macrovasculatura por ultra-sonografia Doppler na esclerose sistêmica

“…O fenômeno de Raynaud (FR), manifestação vascular mais freqüente, e as ulcerações digitais são exemplos comuns das alterações estrutural e funcional da vasculopatia na ES (8)(9)(10) . Estudos recentes também vêem evidenciando crescente acometimento macrovascular em pacientes esclerodérmicos (8,9,(11)(12)(13)(14)(15)(16)(17) , freqüentemente associados à significativa morbimortalidade durante a evolução da doença (18) . Apesar de a doença microvascular ser um dos marcadores da ES, o acometimento da macrovasculatura -doença macrovascular (DMV) -também está presente e não tem sido largamente reconhecido, embora alguns autores tenham sugerido esta associação (19,20) .…”

Envolvimento macrovascular e esclerose sistêmica

“…Stafford et al 25 evidenciaram associação da DMV com o tabagismo e a HAS. Wan et al 10 demonstraram a associação do tabagismo com a diminuição do ITB.…”

A Case of Carotid Artery Stenosis Complicating Scleroderma Treated by Carotid Artery Stenting

“…Since she developed multiple and progressive stenotic disorders in large vessels including the artery, in particular, shows more advanced stenosis than other vessels in scleroderma patients. 9) The patient showed adequate post-procedural vessel dilation (Fig. 6) and no puncture site hematoma or procedural complications.…”

“…Its primary symptoms include Raynaud's phenomenon, sclerosis of the skin of peripheral, occasionally central, parts of the extremities, and lung and kidney disorders, but there have also been reports of stenosis of large vessels such as the pulmonary, carotid, and femoral arteries, and its pathological features are diverse. [1][2][3][4][5][6][7][8][9][10] Carotid artery stenting (CAS) is being established as a treatment for carotid artery stenosis complicating arteriosclerosis obliterans and generalized arteriosclerosis, but reports on its effectiveness and prognosis in carotid artery stenosis associated with scleroderma are few. In this report, we present a patient who underwent CAS for carotid artery stenosis suspected to have been induced by scleroderma and showed a favorable outcome.…”