Distribution of macrovascular disease 1n upper extremities of scleroderma patients

Abstract

Objective: The present work was done to detennine the prevalence of peripheral macrovascular disease of the upper extremity and the associated risk factors among systemic sclerosis (SSe) patients. Patients and Methods: Narrowing and vessel wall thickness of large arteries of upper limb (axilla')', brachial, radial & ulnar) were evaluated and investigated by Doppler ultrasound to assess macrovascular disease in 23 SSe patients. Results: Ten out of23 SSe patients (43.5%) had abnonnal vessel wall thickening compared to none of the controls. The radial rutery was most commonly affected in 34.8% of the cases, then the brachial ru1d ulnar arteries each in 26. I% and the axillary artel)' in 8.7% of the cases. The mean disease duration and skin score were statistically significantly higher in SSe patients that have abnonnal vessel wall thickening. Positive significant correlation of the brachial vessel intraluminal diruneters with HDL and inverse correlation of the ulnar vessel intraluminal diameters with triglycerides were detected. Conclusion: we can conclude that digital ischemia and ulceration in the patient with SSe may be due to large vessel as well as to small vessel disease. Doppler ultrasound is a valid, reliable, and convenient method in the detection and evaluation of macrovascular disease in SSe. Systemic sclerosis patients with higher skin score, increased diastolic blood pressure, longer disease duration, elevated triglycerides, lowered high density lipoproteins should be considered at high risk for the development of macrovascular disease. There is an increased prevalence of macrovascular disease in SSe. Moreover, optimal management of the patient needs to take this into account is an important key point for the clinician.