title: Large vessel occlusive disease associated with CREST syndrome and scleroderma.
abstract: OBJECTIVE
  To report the cases of three patients with CREST syndrome and one patient with diffuse scleroderma who had severe macrovascular disease and only minimal vascular risk factors.
  
  
  METHODS
  The medical histories, physical examinations, and results of clinical investigations were reviewed in four patients.
  
  
  RESULTS
  These four patients had severe morbidity from macrovascular disease of the arms and legs in the presence of minimal underlying vascular risk factors. These patients represent 11% of the women with scleroderma seen at our hospital since 1974. This is a greater than threefold increase above the expected proportion of symptomatic vascular disease seen in population studies. In the patients with CREST syndrome, large vessel disease was first seen more than 10 years after the onset of Raynaud's phenomenon, which was the first manifestation of the disease. A pathological specimen of the ulnar artery from one patient showed severe luminal narrowing by an acellular material with no evidence of atheroma.
  
  
  CONCLUSIONS
  These cases suggest an association of both the CREST syndrome and scleroderma with macrovascular disease.
authors.affiliation: Department of Rheumatology, Prince Henry Hospital, Sydney, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Youssef
authors.forename: H
authors.initials: H
authors.lastname: Englert
authors.forename: J
authors.initials: J
authors.lastname: Bertouch
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000473:pathology; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D005734:Gangrene / Q000150:complications / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011928:Raynaud Disease / Q000150:complications* / Q000473:pathology; D012595:Scleroderma, Systemic / Q000150:complications* / Q000473:pathology; D013577:Syndrome; D013684:Telangiectasis / Q000150:complications / Q000473:pathology; D017535:Ulnar Artery / Q000473:pathology