Vasculitides as a rare cause of intermittent claudication

Abstract

Intermittent claudication of the lower extremities is a common symptom described in older patients with atherosclerotic peripheral arterial disease. Peripheral arterial disease due to atherosclerosis is known to be associated with a higher risk of myocardial infarction, stroke and all-cause mortality. However, if intermittent claudication appears in a younger group of patients or older patients in absence of traditional risk factors for atherosclerosis such as smoking, dyslipidemia, arterial hypertension and diabetes mellitus other causes than atherosclerosis must be considered. These conditions include vasculitides, fi bromuscular dysplasia, cystic adventitial disease, excentric vascular compression by tumor, popliteal artery entrapment syndrome, trauma or dissection. Vasculitides present a heterogenous group of disorders characterized by infl ammatory destruction of blood vessels. Although often not a leading symptom intermittent claudication could be a part of a clinical picture in giant-cell arteritis, Takayasu´s arteritis, Buerger´s disease, polyarteritis nodosa or Behçet disease. Limb claudication is usually of rapid onset, progressive and bilateral. Each of the mentioned vasculitides is specifi c in ethiology and clinical manifestation with a variable prognosis for the patient. Increased awareness of the presence of different causes of limb claudication and their early diagnosis with a prompt initiation of appropriate treatment may help to avoid clinical progression that can lead to vascular surgery or even limb loss (Ref. 37). Full Text in PDF www.elis.sk.

Polyarteritis nodosa presenting as peripheral vascular disease and acute limb ischemia

“…There are few case reports of PAN presenting as PVD and limb vessel involvement. [1234] Similar to our case, the case reported by De Golovine et al . [1] had lower limb ischemia and bilateral femoral artery involvement.…”

“…Thus, in a patient with premature PVD common causes such as family history of premature atherosclerosis, smoking, hyperlipidemia, diabetes mellitus, hypertension, and hypercoagulable states need to be categorically ruled before thinking of primary vasculitis as they are more common. [2] Héron et al . reported a 33-year-old hypertensive woman presenting with acute occlusion of the three infrapopliteal arteries of the right leg that led to the diagnosis of PAN.…”

“…There is lack of epidemiological studies characterizing its prevalence, causes, and approach. There are few reports of polyarteritis nodosa (PAN) presenting as PVD,[12] symmetrical peripheral gangrene,[3] and acute limb ischemia. [4] We report a young man who presented as PVD with acute-on-chronic limb ischemia who was finally diagnosed with PAN.…”

Peripheral Non-atherosclerotic Arterial Disorders

“…GCA is the most common of the vasculitides affecting the peripheral vasculature, which has been reported to be symptomatic in up to 16% of patients with temporal arteritis, with up to a further 16% at risk of rapidly progressing to critical limb ischemia resulting in amputations (29)(30)(31). Assie et al also demonstrated that GCA had a greater predilection for upper limb vasculature of up to 77.7% (31).…”

Nonatherosclerotic Peripheral Artery Disease

“…Other rare diseases, including Cogan's syndrome and relapsing polychondritis, can cause vasculitis of large-or medium-sized vessels. Small-vessel vasculitides include cryoglobulinemic vasculitis, leukocytoclastic vasculitides such as Henoch-Schonlein purpura and isolated cutaneous leukocytoclastic vasculitis, and vasculitis secondary to systemic autoimmune disease, including rheumatoid arthritis, systemic lupus erythematosus (SLE), and scleroderma [30,47]. It is worth noting that there is the possibility of atypical lesion distribution for any type of vasculitides (Figures 10 and 11).…”