Seriès C, Chéradame I, Baste J C, Midy D
Service de Médecine Interne, Hôpital Saint-André, Bordeaux.
Rev Med Interne. 1993 May;14(5):317-9. doi: 10.1016/s0248-8663(05)81307-4.
We report the case of a 62-year old woman hospitalized for acute ischaemia of the right lower limb, caused by stenosis of the superficial femoral artery associated with thrombosis of the deep femoral artery. Thromboendarterectomy was performed, and histology of the operative specimen showed thickening of the media with clusters of giant cells and fragmentation of the internal elastic lamina, without atheroma. The diagnostic of giant cell arteritis was then considered and confirmed by the presence of headaches, 38 degrees C fever and inflammatory syndrome with ESR at 75 mm in the first hour. On the other hand, biopsy of a temporal artery was negative. Corticosteroid therapy was prescribed and gave excellent clinical, laboratory and arteriographic results. It has now been demonstrated that the arteries of the lower limbs may be involved in Horton's giant cell arteritis, which is often overlooked. This involvement is rare and exceptionally proven at histology. Clinically, the most frequently described form is one of pseudo-arteritis with claudication, but a few cases of gangrene have been reported. Withdrawal of corticosteroid might be a facilitating factor. As in our patient, the arteriographic lesions are often segmental, multifocal and symmetrical, predominant in the superficial femoral artery and the arteries of the legs. The lesions regress under corticosteroid therapy, and surgery can usually be avoided. Anticoagulants are commonly prescribed when the large vessels are involved. When surgery is not indicated the diagnosis can be confirmed by biopsy of the temporal artery, which is positive in the majority of cases.
我们报告了一例62岁女性因右下肢急性缺血住院的病例，该急性缺血由股浅动脉狭窄合并股深动脉血栓形成所致。实施了血栓内膜切除术，手术标本的组织学检查显示中膜增厚，伴有巨细胞簇和内弹性膜断裂，无动脉粥样硬化。当时考虑巨细胞动脉炎的诊断，并通过头痛、38摄氏度发热以及炎症综合征（第一小时血沉为75毫米）得以证实。另一方面，颞动脉活检结果为阴性。给予了皮质类固醇治疗，取得了出色的临床、实验室及血管造影结果。现已证明，下肢动脉可能会累及霍顿巨细胞动脉炎，而这种情况常被忽视。这种累及情况罕见，在组织学上也极少得到证实。临床上，最常描述的形式是伴有间歇性跛行的假动脉炎，但也有少数坏疽病例的报道。停用皮质类固醇可能是一个促成因素。正如我们的患者一样，血管造影病变通常呈节段性、多灶性且对称，主要累及股浅动脉和腿部动脉。病变在皮质类固醇治疗下会消退，通常可避免手术。当大血管受累时，通常会开具抗凝剂。当不建议进行手术时，可通过颞动脉活检确诊，大多数情况下活检结果为阳性。
