Omarjee Loukman, Fontaine Cedric, Mahe Guillaume, Jaquinandi Vincent
Unité de Médecine Vasculaire, INSERM CIC 1414, Pôle Imagerie Médicale et Explorations Fonctionnelles, CHU de Rennes, 35033 Rennes Cedex, France. MitoVasc Institute, UMR CNRS 6015-INSERM U1083, Angers University Hospital, Angers Cedex Unité de Médecine Vasculaire, Plateau des Consultations Médicales, Cholet Cedex France.
Medicine (Baltimore). 2017 Jun;96(25):e6988. doi: 10.1097/MD.0000000000006988.
Sildenafil, a phosphodiesterase-5-inhibitor and Bosentan, an endothelin-1-receptor antagonist combined therapy could have beneficial effect in systemic sclerosis (SSc) patients with peripheral artery disease.
We report a case of a 48-year-old Black woman, who developed severe left limb claudication and walking limitation following a left femoropopliteal bypass occlusion in 2014. She was a heavy smoker and had a history of right middle cerebral artery ischemic stroke and bilateral Raynaud phenomenon.
According to the American College of Rheumatology/European League Against Rheumatism-2013 criteria, diagnosis of limited cutaneous SSc was retained with macrovascular lesions. She was referred for investigation of left limb claudication on treadmill using transcutaneous oxygen pressure measurement during exercise to argue for the vascular origin of the walking impairment. She had a severe left limb ischemia and the maximum walking distance (MWD) she reached was 118 m in March 2015 despite the medical optimal treatment and walking rehabilitation.
Sildenafil, 20 mg tid, was introduced due to active digital ulcers. In July 2015, the MWD increased to 288 m, then to 452 m in December 2015. Adding Bosentan to Sildenafil to prevent recurrent digital ulcers resulted in an MWD of 1576 m.
Recently, the patient is treated with the combined therapy. She has no more pain during walking and his quality of life has improved.
Sildenafil and Bosentan combined therapy was associated in our case with an improvement of MWD without adverse effect. Further clinical trials are necessary to confirm our original observation.
西地那非（一种磷酸二酯酶-5抑制剂）与波生坦（一种内皮素-1受体拮抗剂）联合治疗可能对患有外周动脉疾病的系统性硬化症（SSc）患者有益。
我们报告一例48岁黑人女性病例，她在2014年左股腘动脉搭桥闭塞后出现严重的左下肢间歇性跛行和行走受限。她是重度吸烟者，有右大脑中动脉缺血性中风和双侧雷诺现象病史。
根据美国风湿病学会/欧洲抗风湿病联盟2013年标准，确诊为局限性皮肤型SSc并伴有大血管病变。她因左下肢间歇性跛行被转诊，通过运动期间经皮氧分压测量在跑步机上进行检查，以论证行走障碍的血管起源。尽管接受了最佳药物治疗和行走康复训练，但她在2015年3月仍存在严重的左下肢缺血，其最大行走距离（MWD）仅为118米。
因存在活动性指端溃疡，开始使用西地那非，20毫克，每日三次。2015年7月，MWD增加到288米，然后在2015年12月增加到452米。在西地那非基础上加用波生坦以预防复发性指端溃疡，MWD达到了1576米。
最近，该患者接受联合治疗。她行走时不再疼痛，生活质量得到改善。
在我们的病例中，西地那非和波生坦联合治疗与MWD改善相关且无不良反应。需要进一步的临床试验来证实我们最初的观察结果。
