Vasc Spec Int.  2018 Jun;34(2):39-43. 10.5758/vsi.2018.34.2.39.

Detrimental Effects of Endovascular Intervention in Active Rheumatoid Vasculitis

• Park JK

• KMID: 2416380
• DOI: http://doi.org/10.5758/vsi.2018.34.2.39

Abstract

Balloon angioplasty can cause shear stress and tear of the vascular endothelium during mechanical dilatation, leading to increased inflammation and coagulation reactions of the vascular endothelium. Herein, a worst case of active rheumatoid vasculitis is described, where due to progressing ischemic necrosis of the leg, endovascular intervention was unavoidably performed in the presence of active rheumatoid vasculitis. After percutaneous balloon angioplasty, the patient developed recurrent thrombotic occlusion of the leg arteries, and finally, limb amputation resulted in despite vigorous treatment including medication, immunosuppression, catheter-directed thrombolysis, and post-thrombolysis anticoagulation. This case report indicates that endovascular intervention may be detrimental to the active rheumatoid vasculitis. Until the development of treatment guideline to prevent or control inflammatory reaction, endovascular intervention for the active rheumatoid vasculitis may not be appropriate as a first line therapy even though there is progressing ischemic necrosis.

Keyword

Endovascular intervention; Rheumatoid vasculitis; Thrombosis

MeSH Terms

Amputation
Angioplasty, Balloon
Arteries
Dilatation
Endothelium, Vascular
Extremities
Humans
Immunosuppression
Inflammation
Leg
Necrosis
Rheumatoid Vasculitis*
Tears
Thrombosis