Giant cell arteritis presenting as subclavian artery occlusion. A report of two cases

Abstract

Two patients with the aortic arch syndrome and biopsy-proved but asymptomatic temporal giant cell arteritis are described. Corticosteroid treatment was followed by the return of peripheral pulsation in these two patients after an interval of a few months. A review of the literature suggests that of patients where giant cell arteritis causes subclavin obstruction there is an undue predominance of women, compared to the sex ratio found in giant cell arteritis overall.

Critical arm ischemia as rare presentation of giant cell arteritis

“…The mainstay of treatment includes high-dose oral glucocorticoids, and previous studies have reported a return of peripheral pulsation even in patients who had presented with subclavian artery occlusion. 9 Surgical revascularization is, therefore, rare, and only a very few cases of revascularization have been reported in which the patients had presented with critical arm ischemia requiring carotid–brachial artery bypass, as was the case for our patient. 4 , 5 , 10 Also, even when significant stenosis of the arteries is discovered, the distal tissue viability will rarely be compromised, even when ischemic symptoms, such as the loss of pulses, are present, because the gradual development of arterial narrowing will have allowed for the establishment of extensive collateral circulation.…”

Unusual variants in the presentation of temporal arteritis

“…The most commonly involved vessels are superficial temporal, vertebral, ophthalmic and posterior ciliary arteries, which is reflected in the common presentations of scalp tenderness and blindness (Huston et al, 1978). The fact that any vessel may be involved in the disease process is seen in the clinical variants described in the literature (Huston et al, 1978;Healey and Wilske, 1977;Swinson, Goodwill and Talbot, 1976;Medical Practice, 1979;Wilkinson and Ross-Russell, 1972).…”

Atteintes artérielles des membres supérieurs et inférieurs au cours de la maladie de Horton

“…Le diagnostic de localisation artérielle inflammatoire périphéri-que est souvent tardif au cours de la maladie de Horton, en raison de l'absence de spécificité des signes cliniques. Dans notre revue de la littérature, nous avons observé que les manifestations cliniques révélatrices d'une artérite inflammatoire de Horton étaient représentées, en règle générale, par une claudication intermittente d'un membre (68,6 %), une ischémie d'un membre (17,9 %) ou encore une gangrène d'un membre/orteil/doigt (6,4 %) (tableau II) [16,17,21,[24][25][26][27][28][29][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][82][83][84][85][86][87][88][89][90][91][92][93]. Dans un travail récent, les manifestations cliniques révélatrices des atteintes artérielles des membres supérieurs et/ou inférieurs étaient principalement : une claudication intermittente d'un membre, une diminution/abolition d'un pouls périphérique ; les complications ischémiques (troubles trophiques, ulcères) n'étaient pas rares puisqu'elles étaient relevées dans 27,4 % des cas [12].…”