Yasser Emad1, Hend Al-Sherbeni2, Yasser Ragab3, Ihab Abo-El-Youn2, Nashwa El-Shaarawy4, Dina Y Nassar5, Ahmed Fathy6, Hadeel Al-Hanafi7, Johannes J Rasker8. 1. Rheumatology and Rehabilitation Department, Faculty of medicine Cairo University, Cairo, Egypt; Rheumatology and Rehabilitation Department, Faculty of medicine, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia. Electronic address: yasseremad68@yahoo.com. 2. Rheumatology and Rehabilitation Department, Faculty of medicine Cairo University, Cairo, Egypt. 3. Radiology Department, Faculty of medicine, Cairo University, Cairo, Egypt; Radiology Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia. 4. Rheumatology and Rehabilitation Department, Suez Canal University, Ismailia, Egypt. 5. Cardiology Department, Al-Azhar university, Faculty of Medicine, Cairo, Egypt. 6. Internal medicine department faculty of medicine Cairo University, Cairo, Egypt. 7. Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. 8. Rheumatology Department, University of Twente, Enschede, The Netherlands.
Abstract
OBJECTIVE: To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration. METHODS: Twenty-two cases with systemic sclerosis (12 limited and 10 diffuse) were recruited for the study. All patients fulfilled the American Rheumatism Association (ACR) criteria for the classification of SSc. For all patients routine laboratory investigations were performed including complete lipid profile. Computed tomography angiography (CTA) studies for the whole upper limb arterial tree were performed for both upper limbs in all cases. RESULTS: CTA studies showed involvement of subclavian arteries in 3 cases and axillary artery was involved in five cases. Brachial artery was affected in 5 cases. In the forearm the radial artery was affected in 4 cases with bilateral involvement in two cases (6 vessels), while ulnar artery was affected in five cases. Unilateral non visualization of the superficial palmar arch was observed in two cases with limited disease, while thinning out of the vessel wall with poor distal run off in 18 cases. A higher number of arterial vasculopathy was significantly associated with systolic pulmonary artery pressure (P=0.001). CONCLUSIONS: Macrovascular arterial vasculopathy of upper limbs may occur in SSc irrespective of the disease pattern. Major arteries can be affected in association with other medium sized arteries of the forearms and microvascular arterial branches of the hands.
OBJECTIVE: To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration. METHODS: Twenty-two cases with systemic sclerosis (12 limited and 10 diffuse) were recruited for the study. All patients fulfilled the American Rheumatism Association (ACR) criteria for the classification of SSc. For all patients routine laboratory investigations were performed including complete lipid profile. Computed tomography angiography (CTA) studies for the whole upper limb arterial tree were performed for both upper limbs in all cases. RESULTS: CTA studies showed involvement of subclavian arteries in 3 cases and axillary artery was involved in five cases. Brachial artery was affected in 5 cases. In the forearm the radial artery was affected in 4 cases with bilateral involvement in two cases (6 vessels), while ulnar artery was affected in five cases. Unilateral non visualization of the superficial palmar arch was observed in two cases with limited disease, while thinning out of the vessel wall with poor distal run off in 18 cases. A higher number of arterial vasculopathy was significantly associated with systolic pulmonary artery pressure (P=0.001). CONCLUSIONS:Macrovascular arterial vasculopathy of upper limbs may occur in SSc irrespective of the disease pattern. Major arteries can be affected in association with other medium sized arteries of the forearms and microvascular arterial branches of the hands.
Authors: Sheraz A Butt; Jørgen L Jeppesen; Christian Torp-Pedersen; Flora Sam; Gunnar H Gislason; Søren Jacobsen; Charlotte Andersson Journal: J Am Heart Assoc Date: 2019-08-24 Impact factor: 5.501