title: Severe symptomatic stenosis of visceral and renal arteries leading primary antiphospholipid syndrome diagnosis.
abstract: Antiphospholipid syndrome (APS) is an autoimmune disorder with combination of at least 1 clinical and 1 laboratory criterion as defined by the SAPPORO statement. Clinical criteria result from vascular thrombosis that can affect artery, venous, or small vessel in any tissue or organ. Arterial stenosis is a rare lesion involved in APS, affecting mainly renal or intracranial arteries. We reported a case of a 33-year-old woman with abdominal angina and high blood pressure (BP). Imaging showed tight, not calcified, and hypodense stenosis of mesenteric superior artery and left renal artery, and a thrombosis of the celiac trunk. Treatment was digestive rest followed by angioplasty and stenting of mesenteric and renal artery, anticoagulation, antiplatelet, and statin therapy. Normal BP and digestive function were obtained postoperatively. Biological tests showed a positive lupus anticoagulant at diagnosis and at 12 weeks, which allowed us to make the diagnosis of APS. Physiopathology of stenosis in APS remains unclear but suggests arterial wall partial thrombosis, accelerated atherosclerosis, and/or proliferation of smooth muscle cells. We recommend screening of arterial stenosis in patients with APS and arterial symptoms, and inversely, searching for APS in young patients with atypical arterial stenosis to allow optimal therapy.
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Marseille, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Salaun
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Marseille, France.
authors.forename: Michel Alain
authors.initials: MA
authors.lastname: Bartoli
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Marseille, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Soler
authors.affiliation: Service de Médecine interne, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Conception, Marseille, France.
authors.forename: Hajar
authors.initials: H
authors.lastname: Khibri
authors.affiliation: Service de Médecine interne, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Conception, Marseille, France.
authors.forename: Mickael
authors.initials: M
authors.lastname: Ebbo
authors.affiliation: Service de Médecine interne, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Conception, Marseille, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bernit
authors.affiliation: Service de Radiologie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Marseille, France.
authors.forename: Antonin
authors.initials: A
authors.lastname: Flavian
authors.affiliation: Service de Médecine interne, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Conception, Marseille, France.
authors.forename: Jean Robert
authors.initials: JR
authors.lastname: Harlé
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Marseille, France.
authors.forename: Pierre Edouard
authors.initials: PE
authors.lastname: Magnan
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Marseille, France. Electronic address: gabrielle.sarlon@ap-hm.fr.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Sarlon-Bartoli
mesh_terms: D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011150:Popliteal Artery