Involvement of the Femoropopliteal Arteries in Giant Cell Arteritis: Clinical and Color Duplex Sonography

Abstract

Femoropopliteal artery involvement appears to be a clinically relevant manifestation of GCA, frequently leading to symptomatic lower extremity ischemia. CDS of the femoropopliteal arteries is a noninvasive diagnostic tool for detection of lower extremity vasculitis in GCA.

Vasculitides as a rare cause of intermittent claudication

“…GCA of femoropopliteal arteries was present in half of the patients, developed bilaterally and every second patient with positive sonography fi nding was symptomatic either in means of claudication or symptoms of critical limb ischemia. In contrast to atherosclerotic etiology, ischemic symptoms in patients with GCA progressed rapidly and lead to development of limb-threatening ischemia within very short of time (15). Assie and his colleagues came up with similar results demonstrating a common presence of upper and lower extremity involvement in GCA even in early phase of disease (16).…”

“…Claudication can be managed by conservative treatment in most cases, but severe deterioration leading to even limb amputation is also a threat (16,17,18). Some studies using ultrasound also found quite a frequent presence of atherosclerotic plaques in lower extremity arteries in patients older than 50 years (15,19). Atherosclerosis must be recognised as a possible co-factor in elderly but if acute bilateral and rapidly progressive claudication occurs especially in association with a systemic infl ammatory disorder of unknown origin suspicion for possible extracranial GCA must be taken into consideration (15,1 7).…”

Dr. Czihal replies: Figure 1.

“…Of note, vasculitis of the subclavian and/or axillary arteries was detected in 74.2% of our patients with involvement of the femoropopliteal arteries and in all except 1 patient with carotid artery involvement by CDS criteria 2,4 . Therefore, a sonographic finding consistent with vasculitis of the proximal arm arteries strongly supports a suspected diagnosis of GCA of the lower extremity or carotid arteries.…”

“…We appreciate the comments from Milchert, et al 1 on our study evaluating the involvement of femoropopliteal arteries in giant cell arteritis (GCA) 2 . In their letter, they describe 2 cases with different clinical manifestations of extracranial GCA, including 1 patient with suspected vasculitis of the lower extremities.…”

“…It is of interest in this context that, as a result of the high prevalence of arteriosclerosis of lower extremity arteries in the elderly population with GCA, 18F fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging has a low specificity for diagnosis of vasculitis of the lower extremity arteries 7 . It is our hypothesis that concomitant arteriosclerosis of the lower extremity arteries results in the sonographic "beaded tube" appearance of the innermost layer of the thickened vessel wall in vasculitis of the femoropopliteal arteries (Figure 1) 2,6 .…”