Isquemia crítica dos membros superiores – Manifestação inicial de arterite de células gigantes – Caso clínico

Abstract

Introduction

Giant Cell Arteritis (GCA) is a systemic inflammatory vasculitis of unknown etiology that occurs in older persons and can result in a wide variety of clinical presentations. The disease most commonly affects the extracranial branches of the carotid artery but has also been shown to involve, in 10 to 15%, the upper extremity arteries, mostly the subclavian, axillary and proximal brachial arteries.

Clinical Case

A 80 year‐old woman with a prior history of hypertension and cerebrovascular disease presented with ischemic rest pain of both upper limbs, with evidence of distal digital cyanosis. Complaints began two months earlier and progressively worsened. Workup CT‐scan showed complete occlusion of both axillary and proximal branchial arteries and thickening of the wall of both subclavian arteries, aorta and common femoral arteries suggesting vasculitis.

Corticosteroid therapy was promptly commenced. No significant improvement was present after 5 days of treatment, so the patient underwent bilateral carotid‐brachial bypass. After surgery there was complete resolution of the complaints and radial pulse was present bilaterally. After 6 months, the patient remained asymptomatic and bypasses were permeable.

Conclusion

This paper aims to present the case of a patient with the inaugural diagnosis of GCA who presented with bilateral and simultaneous critical ischemia. This condition required the realization of a rare revascularization procedure.