title: Lower extremity vasculitis in giant cell arteritis: important differential diagnosis in patients with lower limb claudication.
abstract: Most patients with peripheral arterial disease suffer from arteriosclerosis, the prevalence of which increases with age. In some of these patients, however, the ischemic symptoms are not caused by stenotic arteriosclerosis, but by large vessel giant cell arteritis (LV-GCA), a disease also predominantly affecting patients of the older generation. Identifying large vessel vasculitis is a challenge for all physicians caring for patients with peripheral artery disease. The results of invasive treatment such as bypass surgery and angioplasty of inflammatory vascular lesions differ fundamentally from those of patients with atherosclerosis. Duplex ultrasound is a widely available diagnostic method for examining patients with lower limb claudication and pathological ankle-/toe- brachial index or pulse volume recording with or without exercise. Knowledge of characteristic sonographic findings suspicious about large vessel vasculitis is essential for a differential diagnosis of vasculitis versus atherosclerosis. In addition to clinical and laboratory findings, further imaging techniques, e.g. contrast-enhanced computed tomography, magnetic resonance imaging or a combination of positron emission tomography and computed tomography (PET-CT) can provide information on further vessel involvement and inflammatory activity. The present study focuses on diagnostic imaging of LV-GCA in patients presenting with claudication, illustrated by a series of cases.
authors.affiliation: Department of Angiology and Cardiology, Diakonissenkrankenhaus Mannheim.
authors.forename: Martin
authors.initials: M
authors.lastname: Sigl
authors.affiliation: Department of Angiology and Cardiology, Diakonissenkrankenhaus Mannheim.
authors.forename: Eric
authors.initials: E
authors.lastname: Hsu
authors.affiliation: Department of Radiology, Diakonissenkrankenhaus Mannheim.
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg.
authors.forename: Stefan
authors.initials: S
authors.lastname: Haneder
authors.affiliation: Department of Vascular Surgery, Diakonissenkrankenhaus Mannheim.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rümenapf
authors.affiliation: Department of Angiology and Cardiology, Diakonissenkrankenhaus Mannheim.
authors.forename: Klaus
authors.initials: K
authors.lastname: Amendt
mesh_terms: D000465:Algorithms; D019091:Critical Pathways; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D013700:Giant Cell Arteritis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D035002:Lower Extremity / Q000098:blood supply*; D064847:Multimodal Imaging; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D014657:Vasculitis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D057188:Workflow
keywords: Large vessel vasculitis; giant cell arteritis; lower limb claudication