Isquemia Cr��tica dos Membros Superiores. Manifesta����o Inicial de Arterite de Células Gigantes - Caso Cl��nico

Introdu����o: A arterite de células gigantes (ACG), de etiologia desconhecida, �� a vasculite sist��mica mais comum nos adultos e pode ter uma ampla variedade de apresenta����es cl��nicas. Atinge mais frequentemente os ramos extracranianos da art��ria car��tida mas, em 10-15% dos casos, pode ocorrer o envolvimento das art��rias subcl��via, axilar e braquial. Caso cl��nico: Tratava-se de uma doente do sexo feminino, de 80 anos, com antecedentes de HTA e doen��a cerebrovascular. Foi observada no servi��o de urg��ncia por arrefecimento e dor em repouso nos membros superiores, com evid��ncias de cianose digital distal bilateral. As queixas tinham tido in��cio 2 meses antes e agravamento progressivo desde ent��o. Realizou um angio-TC que mostrou a exist��ncia de oclus��o de ambas as art��rias axilares/braquiais proximais e imagens sugestivas de vasculite ao n��vel de ambas as art��rias subcl��vias, aorta e art��rias femorais comuns. Foi medicada com corticoterapia; contudo, por n��o apresentar melhoria signi���cativa ap��s 5 dias, optou-se por realizar um bypass carot��deo-umeral bilateral. Ap��s a cirurgia, ocorreu resolu����o completa das queixas e a doente apresentava pulso radial palp��vel bilateralmente. Seis meses ap��s a cirurgia, a doente encontrava-se assintom��tica e os bypasses perme��veis. Conclus��o: O presente trabalho pretende expor o caso de uma doente com o diagn��stico inaugural e ACG,que se apresentou com isquemia cr��tica bilateral e simult��nea. Este quadro cl��nico exigiu a realiza����o de um procedimento de revasculariza����o raro.

Acute Upper Limb Ischemia, a Rare Presentation of Giant Cell Arteritis

Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10-15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis. We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure. The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers. GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization.