eMedicine Specialties > Radiology > Vascular/Interventional

Temporal Arteritis: Follow-up

Author: Anthony W Allen, MD, Chief, Interventional Radiology, Brooke Army Medical Center; Associate Professor of Radiology, Uniformed Services University of the Health Sciences
Coauthor(s): Timothy Biega, MD, Staff Physician, Department of Radiology, Tripler Regional Medical Center; Manish K Varma, MD, Chief of Interventional Radiology, Department of Radiology, Tripler Army Medical Center
Contributor Information and Disclosures

Updated: Oct 2, 2008

Intervention

Angioplasty and stent placement have been used in patients with ischemic symptoms who were not adequately treated with corticosteroid therapy. (As many as 58% of patients receiving long-term steroid therapy will have a major adverse effect. These include avascular necrosis of the hip, diabetes, congestive heart failure, peptic ulcers, hypertension, fractures, and depressive psychosis.)25

Medicolegal Pitfalls

  • The failure to consider the diagnosis of temporal arteritis (giant cell arteritis) in an older patient with systemic complaints is the most likely medical pitfall.
  • The failure to diagnose temporal arteritis with the prompt initiation of corticosteroid therapy may lead to ischemia and blindness.
  • Ruling out temporal arteritis on the basis of a negative radiologic imaging study alone is a pitfall.

Special Concerns

  • No radiologic finding is specific for the diagnosis of temporal arteritis (giant cell arteritis) alone. Imaging studies are helpful in determining the extent of involvement and in identifying unsuspected areas of involvement.
  • Special care must be taken when invasive procedures such as arteriography are performed, because complications may occur.
    • Patients with temporal arteritis are older than other patients, and they may have concomitant illnesses that increase the risk of a procedure.
    • Patients with atherosclerotic disease or renal insufficiency have an increased risk of procedural complications.
    • The risk of a potentially serious reaction to the contrast material also must be taken into consideration.
 


More on Temporal Arteritis

Overview: Temporal Arteritis
Imaging: Temporal Arteritis
Follow-up: Temporal Arteritis
References
Further Reading
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References

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  2. Schmidt WA. Takayasu and temporal arteritis. Front Neurol Neurosci. 2006;21:96-104. [Medline].

  3. Tatò F, Hoffmann U. Giant cell arteritis: a systemic vascular disease. Vasc Med. 2008;13(2):127-40. [Medline].

  4. Tehrani R, Ostrowski RA, Hariman R, Jay WM. Giant cell arteritis. Semin Ophthalmol. Mar-Apr 2008;23(2):99-110. [Medline].

  5. Cantini F, Niccoli L, Nannini C, Bertoni M, Salvarani C. Diagnosis and treatment of giant cell arteritis. Drugs Aging. 2008;25(4):281-97. [Medline].

  6. Thielen KR, Wijdicks EF, Nichols DA. Giant cell (temporal) arteritis: involvement of the vertebral and internal carotid arteries. Mayo Clin Proc. May 1998;73(5):444-6. [Medline].

  7. Elliott PD, Baker HL Jr, Brown AL Jr. The superficial temporal artery angiogram. Radiology. Mar 1972;102(3):635-8. [Medline].

  8. Hunder GG, Arend WP, Bloch DA. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Introduction. Arthritis Rheum. Aug 1990;33(8):1065-7. [Medline].

  9. Matteson EL, Gold KN, Bloch DA. Long-term survival of patients with giant cell arteritis in the American College of Rheumatology giant cell arteritis classification criteria cohort. Am J Med. Feb 1996;100(2):193-6. [Medline].

  10. Devauchelle-Pensec V, Jousse S, Destombe C, Saraux A. Epidemiology, imaging, and treatment of giant cell arteritis. Joint Bone Spine. May 2008;75(3):267-72. [Medline].

  11. Melson MR, Weyand CM, Newman NJ, Biousse V. The diagnosis of giant cell arteritis. Rev Neurol Dis. Summer 2007;4(3):128-42. [Medline].

  12. Dellaripa PF, Eisenhauer AC. Bilateral percutaneous balloon angioplasty of the axillary arteries in a patient with giant cell arteritis and upper extremity ischemic symptoms not responsive to corticosteroids. J Rheumatol. Jul 1998;25(7):1429-33. [Medline].

  13. Botella-Estrada R, Sammartin O, Martinez V. Magnetic resonance angiography in the diagnosis of a case of giant cell arteritis manifesting as scalp necrosis. Arch Dermatol. Jul 1999;135(7):769-71. [Medline].

  14. Harada S, Mitsunobu F, Kodama F. Giant cell arteritis associated with rheumatoid arthritis monitored by magnetic resonance angiography. Intern Med. Aug 1999;38(8):675-8. [Medline].

  15. Mitomo T, Funyu T, Takahashi Y. Giant cell arteritis and magnetic resonance angiography. Arthritis Rheum. Sep 1998;41(9):1702. [Medline].

  16. Schmidt WA, Kraft HE, Vorpahl K. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med. Nov 6 1997;337(19):1336-42. [Medline].

  17. Myers KA, Farquhar DR. Ultrasonography in temporal arteritis. N Engl J Med. Mar 12 1998;338(11):760; discussion 761. [Medline].

  18. Schmidt WA, Kraft HE, Borkowski A. Color duplex ultrasonography in large-vessel giant cell arteritis. Scand J Rheumatol. 1999;28(6):374-6. [Medline].

  19. Hunder GG, Weyand CM. Sonography in giant-cell arteritis. N Engl J Med. Nov 6 1997;337(19):1385-6. [Medline].

  20. Puechal X, Chauveau M, Menkes CJ. Temporal Doppler-flow studies for suspected giant-cell arteritis. Lancet. Jun 3 1995;345(8962):1437-8. [Medline].

  21. Blockmans D, Stroobants S, Maes A. Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med. Feb 15 2000;108(3):246-9. [Medline].

  22. Anders HJ, Sigl T, Sander A. Gadolinium contrast magnetic resonance imaging of the temporal artery in giant cell arteritis. J Rheumatol. Oct 1999;26(10):2287-8. [Medline].

  23. Bley TA, Uhl M, Carew J, Markl M, Schmidt D, Peter HH, et al. Diagnostic value of high-resolution MR imaging in giant cell arteritis. AJNR Am J Neuroradiol. Oct 2007;28(9):1722-7. [Medline].

  24. Khoury JA, Hoxworth JM, Mazlumzadeh M, Wellik KE, Wingerchuk DM, Demaerschalk BM. The Clinical Utility of High Resolution Magnetic Resonance Imaging in the Diagnosis of Giant Cell Arteritis: A Critically Appraised Topic. Neurologist. Sep 2008;14(5):330-335. [Medline].

  25. Nesher G, Sonnenblick M, Friedlander Y. Analysis of steroid related complications and mortality in temporal arteritis: a 15-year survey of 43 patients. J Rheumatol. Jul 1994;21(7):1283-6. [Medline].

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Further Reading

Related eMedicine topics

 Temporal (Giant Cell) Arteritis  (Dermatology)

Temporal Arteritis  (Emergency Medicine)

Temporal/Giant Cell Arteritis  (Neurology)

Giant Cell Arteritis  (Ophthalmology)

Arteritis, Giant Cell  (Radiology)

Giant Cell Arteritis  (Rheumatology)

Clinical guidelines
Diagnosis and treatment of headache .
Institute for Clinical Systems Improvement.  1998 Aug (revised 2007 Jan).  72 pages.  NGC:005845

Treatment of primary headache: chronic daily headache. Standards of care for headache diagnosis and treatment .
National Headache Foundation.  2004.  8 pages.  NGC:004143
 
Headache.
American College of Radiology.  1996 (revised 2006).  8 pages.  NGC:005120

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Keywords

temporal arteritis, Horton giant cell arteritis, Horton disease, Horton's disease, Horton's giant cell arteritis, giant cell aortic arteritis, giant cell aortitis, juvenile temporal arteritis, central nervous system vasculitis, CNS vasculitis, giant cell arteritis, systemic vasculitis, temporal arteries, GCA, cranial arteritis, granulomatous arteritis

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Contributor Information and Disclosures

Author

Anthony W Allen, MD, Chief, Interventional Radiology, Brooke Army Medical Center; Associate Professor of Radiology, Uniformed Services University of the Health Sciences
Anthony W Allen, MD is a member of the following medical societies: American College of Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Timothy Biega, MD, Staff Physician, Department of Radiology, Tripler Regional Medical Center
Disclosure: Nothing to disclose.

Manish K Varma, MD, Chief of Interventional Radiology, Department of Radiology, Tripler Army Medical Center
Manish K Varma, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Anthony Watkinson, MD, Professor of Interventional Radiology, The Peninsula Medical School; Consultant and Senior Lecturer, Department of Radiology, The Royal Devon and Exeter Hospital, UK
Anthony Watkinson, MD is a member of the following medical societies: Radiological Society of North America, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Douglas M Coldwell, MD, PhD,, Principal, Coldwell Associates. Interventional Radiologist, Jane Phillips Medical Center, Bartlesville, OK
Douglas M Coldwell, MD, PhD, is a member of the following medical societies: American Association for Cancer Research, American College of Radiology, American Heart Association, American Physical Society, American Roentgen Ray Society, Society of Cardiovascular and Interventional Radiology, Southwest Oncology Group, and Special Operations Medical Association
Disclosure: Sirtex, Inc. Consulting fee Speaking and teaching

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Kyung J Cho, MD, FACR, William Martel Professor of Radiology, Interventional Radiology Fellowship Director, University of Michigan Health System
Kyung J Cho, MD, FACR is a member of the following medical societies: American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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