Giant cell arteritis as unusual cause of critical arm ischemia

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Giant cell arteritis as unusual cause of critical arm ischemia Thomas Ratschiller, MD, Hannes Müller, MD, Markus Pirklbauer, MD, PhD, Rene Silye, MD, Gregor Sulzbacher, Andreas Zierer, MD Journal of Vascular Surgery Cases and Innovative Techniques Volume 4, Issue 3, Pages 248-251 (September 2018) DOI: 10.1016/j.jvscit.2018.05.005 Copyright © 2018 The Authors Terms and Conditions

Fig 1 A, Duplex ultrasound image of the axillary artery in the longitudinal view demonstrating a hypoechoic circumferential vessel wall edema (halo sign) with consecutive subtotal stenosis. B, Coronal reconstruction of the 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan demonstrating increased tracer uptake in the subclavian and axillary arteries. C, Computed tomography angiography displaying vessel wall thickening of the ascending and descending thoracic aorta. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 248-251DOI: (10.1016/j.jvscit.2018.05.005) Copyright © 2018 The Authors Terms and Conditions

Fig 2 A, Cinematic rendering (syngo.via Frontier, version 1.0.0; Siemens, Munich, Germany) after implantation of a bilateral carotid-brachial artery bypass using a 6-mm ringed polytetrafluoroethylene graft (Gore Propaten; W. L. Gore & Associates, Flagstaff, Ariz). The arrow indicates occlusion of the left subclavian artery. B, Exposure of the common carotid artery through a supraclavicular horizontal incision with medial retraction of the sternocleidomastoid muscle. The proximal anastomosis is performed end to side using a running 6-0 polypropylene suture. C, Distal anastomosis to the brachial artery end to side using a running 6-0 polypropylene suture. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 248-251DOI: (10.1016/j.jvscit.2018.05.005) Copyright © 2018 The Authors Terms and Conditions

Fig 3 Histologic section of the occluded axillary artery demonstrating a mononuclear inflammatory infiltrate. There is fragmentation of elastic fibers and a giant cell reaction of Langhans type (right upper corner). The intima is replaced by an old organized thrombus. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 248-251DOI: (10.1016/j.jvscit.2018.05.005) Copyright © 2018 The Authors Terms and Conditions