Giant Cell Arteritis Presenting as Critical Lower Limb Ischemia

Abstract

A 62-year-old woman presented with ischemic pain of her lower limb on 2 occasions, without upper limb or cranial vessel involvement. She was treated with open bypass of her left lower limb when she presented with critical limb ischemia during her second admission. Although bilateral temporal artery biopsies were negative, superficial femoral artery biopsy at the time of surgery confirmed the diagnosis of giant cell arteritis. Corticosteroid therapy was promptly commenced.

Isquemia de extremidades inferiores secundaria a arteritis de la arteria temporal

“…El inicio precoz de terapia con corticoides es fundamental para evitar progresión de la enfermedad que puede llegar a comprometer la viabilidad de la extremidad, con una respuesta clínica rápida en etapas agudas 12 . En esta paciente dado la recaída de su enfermedad sitémica al bajar la dosis de esteroides, el tratamiento con Tocilizumab permitió la remisión mantenida de la vasculitis y fue útil para bajar la dosis de esteroides, evitando sus complicaciones.…”

“…El tratamiento quirúrgico con puentes arteriales ha presentado alta tasa de oclusión precoz 12 . Se ha descrito angioplastia con balón como terapia adyuvante al pulso de corticoides logrando tasas de permeabilidad primaria y secundaria de 65,2 y 89,7% respectivamente 14 .…”

Isolated lower extremity vasculitis leading to progressive critical limb ischemia

“… 2 , 12 In our review, patients have been shown to develop ischemic complications after initiation of steroid therapy. 4 , 8 , 9 , 13 …”

Peripheral Non-atherosclerotic Arterial Disorders

“…In a series of 10 patients, Both et al demonstrated a 100% resolution of stenosis following angioplasty; however, 50% had developed restenosis on 5 months' followup (35). Loo et al demonstrated variable surgical success rates from 60% to 100% (36).…”