title: Arteriographic evaluation of vascular changes of the extremities in patients with systemic sclerosis.
abstract: BACKGROUND
  Although digital ulcerations frequently occur in patients with systemic sclerosis (SSc), there have been few reports on the macrovascular involvement.
  
  
  OBJECTIVE
  To evaluate the macrovascular involvement in patients with SSc exhibiting digital ulceration or gangrene.
  
  
  METHODS
  Transfemoral catheter arteriography of the upper and/or lower extremities was performed in eight patients (one man and seven women, age range 42-71 years) with SSc exhibiting digital ulceration or gangrene. The background of the patients, such as autoantibody profiles and vascular risk factors including smoking habits, was also investigated.
  
  
  RESULTS
  Macrovascular involvement was detected in seven of eight patients. In three of seven patients who underwent arteriography of the upper extremity, occlusion was limited to the digital arteries. Obliteration of the ulnar artery and superficial palmar arch was detected in three of seven patients, and the radial artery in one patient. Only one of five patients who underwent arteriography of the lower extremity showed the occlusion limited to digital arteries of the foot. Occlusion of the posterior tibial artery, dorsalis pedis artery and arcuate artery was detected, each in one patient. Two patients showed occlusion of the plantar arch. Overall, the occlusion of arteries proximal to the digits was demonstrated in four of eight patients. Three of the four patients were positive for antitopoisomerase-1 antibody and had diffuse cutaneous SSc (dcSSc) with multiple skin ulcers or gangrene.
  
  
  CONCLUSIONS
  Macrovascular involvement as detected with arteriography is not rare in SSc patients with digital ulceration or gangrene. Moreover, the vascular occlusion proximal to the digits seemed to be frequent in antitopoisomerase-1 antibody-positive dcSSc patients with multiple skin ulcers or gangrene.
authors.affiliation: Department of Dermatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, Japan. michiko@mail.gunma.med.or.jp
authors.forename: M
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Y
authors.initials: Y
authors.lastname: Nagai
authors.forename: A
authors.initials: A
authors.lastname: Tamura
authors.forename: O
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D005260:Female; D005528:Foot / Q000098:blood supply* / Q000000981:diagnostic imaging; D005734:Gangrene / Q000209:etiology*; D006225:Hand / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology; D012883:Skin Ulcer / Q000209:etiology*; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D017535:Ulnar Artery / Q000000981:diagnostic imaging / Q000473:pathology