Combined medical, surgical and endovascular treatment of a giant cell arteritis case manifesting as upper limbs acute ischemia

Stefano de Franciscis; Giuseppe Roscitano; Raffaele Serra; Gianluca Buffone; Attilio Cotroneo; Andrea de Franciscis; Diego Mastrangelo; Francesco Spinelli

doi:10.1016/j.ijscr.2011.02.003

Combined medical, surgical and endovascular treatment of a giant cell arteritis case manifesting as upper limbs acute ischemia

Int J Surg Case Rep. 2011;2(5):71-3. doi: 10.1016/j.ijscr.2011.02.003. Epub 2011 Feb 15.

Authors

Stefano de Franciscis¹, Giuseppe Roscitano², Raffaele Serra³, Gianluca Buffone⁴, Attilio Cotroneo⁵, Andrea de Franciscis⁶, Diego Mastrangelo⁷, Francesco Spinelli⁸

Affiliations

¹ Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Unit of Vascular Surgery, Viale Europa 88100 Catanzaro, Italy. Electronic address: defranci@unicz.it.
² Department of Vascular Surgery, Sant'Anna Hospital, Via Pio X, Catanzaro, Italy. Electronic address: giuseppe.roscitano@virgilio.it.
³ Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Unit of Vascular Surgery, Viale Europa 88100 Catanzaro, Italy. Electronic address: rserra@unicz.it.
⁴ Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Unit of Vascular Surgery, Viale Europa 88100 Catanzaro, Italy. Electronic address: buffonegianluca@yahoo.it.
⁵ Department of Vascular Surgery, Sant'Anna Hospital, Via Pio X, Catanzaro, Italy. Electronic address: attiliocotroneo@tiscali.it.
⁶ Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Unit of Vascular Surgery, Viale Europa 88100 Catanzaro, Italy. Electronic address: sangioacchino@hotmail.com.
⁷ Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Unit of Vascular Surgery, Viale Europa 88100 Catanzaro, Italy. Electronic address: dielo@hotmail.it.
⁸ Department of Thoracic and Cardiovascular Surgery, University of Messina, Messina, Italy. Electronic address: fspinelli@unime.it.

Abstract

We report a case of giant cell arteritis manifesting as upper limbs ischemia due to a complete occlusion of the left subclavian artery and a high grade stenosis of the right subclavian artery. We decided to use a combined medical, surgical and endovascular treatment followed by long term treatment with methotrexate. After 4years the patient had no signs or symptoms of relapse. In our personal experience long term treatment with Methotrexate demonstrated a certain efficacy in avoiding relapse of the inflammatory phase and in maintaining stability of results in this kind of disease.

Keywords: Giant cell arteritis, Acute ischemia, Endovascular and surgical treatment; Methotrexate, Cyclophosphamide, Prednisone.