Balloon angioplasty of arteries of the upper extremities in patients with extracranial giant-cell arteritis

• Published in: Annals of the rheumatic diseases 2006-09, Vol.65 (9), p.1124-1130
• Main Authors: Both, M, Aries, P M, Müller-Hülsbeck, S, Jahnke, T, Schäfer, P J, Gross, W L, Heller, M, Reuter, M
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Angioplasty, Balloon - methods; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - therapy; Biological and medical sciences; Blood pressure; C reactive protein; Combined Modality Therapy; CRP; digital subtraction angiography; Disease; Diseases of the osteoarticular system; DSA; ERS; erythrocyte sedimentation rate; Extended Report; Female; Follow-Up Studies; GCA; Giant Cell Arteritis - complications; Giant Cell Arteritis - diagnostic imaging; Giant Cell Arteritis - therapy; giant-cell arteritis; Humans; Immunosuppressive Agents - therapeutic use; magnetic resonance angiography; Medical imaging; Medical sciences; Medical treatment; Middle Aged; MRA; Patients; percutaneous transluminal angioplasty; PTA; Radiography; Recurrence; Rheumatology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Success; Treatment Outcome; Ultrasonic imaging; Upper Extremity - blood supply; Vascular Patency; Veins & arteries
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2005.048470

Objectives: To evaluate the outcome of balloon angioplasty in the arteries of the upper extremities in patients with giant-cell arteritis (GCA) and stenosing extracranial involvement. Methods: Percutaneous transluminal angioplasty (PTA) for symptomatic upper limb artery stenoses (n = 29) and occlusions (n = 1) resistant to medical treatment was carried out in 10 patients (all women, mean age 65 years) with GCA. Vascular lesions were located in the subclavian (n = 4), axillary (n = 10) and brachial (n = 16) arteries. Interventional treatment was accompanied by immunosuppressive drugs in all patients. Follow-up included clinical and serological examination, magnetic resonance angiography and colour duplex ultrasound. Results: Initial technical success of angioplasty was achieved in the case of all vascular lesions. In five patients, marked recurrent stenoses (vascular territories; n = 10/30) were found during follow-up (mean 24 months). The cumulative primary patency rate was 65.2%. All recurrent lesions developed in the territories of the initial long-segment stenoses. Repeated PTA (vascular territories, n = 8; patients, n = 5) provided a cumulative secondary patency rate of 82.6% and a cumulative tertiary patency rate of 89.7%. Conclusions: Despite a tendency to restenoses, balloon angioplasty of the upper-extremity artery, in combination with immunosuppressive treatment, is an efficient method for the treatment of extracranial GCA.