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Catheter angiography and angioplasty in patients with scleroderma

E A Dick, FRCR 1 R Aviv, FRCR 1 I Francis, FRCR 1 G Hamilton, FRCS 2 D Baker, FRCS 2 C Black, FRCP 3 A Platts, FRCR 1 and A Watkinson, FRCR 1

Departments of 1Radiology, 2Vascular Surgery and 3Rheumatology, Royal Free Hospital, Pond Street, London NW3 2QG, UK



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  		Figure 1. Modified Brewster classification of disease of the upper and lower limb. (a) Type 1 disease: involving the aortoiliac vessels in the lower limb, and the aortic arch and great vessels in the upper limb. (b) Type II disease: aorta to external iliac or femoral arteries (lower limb), or aorta to axillary arteries (upper limb). (c) Type III disease: multilevel disease in the upper and lower limbs. (d) Type IV disease: vessels above the knee or elbow are normal but vessels below the knee or elbow are diseased.

 


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  		Figure 2. Digital subtraction angiography of the wrist and hand in a 51-year-old female with limited scleroderma. Type IV (distal) disease in the upper limb. Normal vessels above the elbow (not seen), with tapering and obliteration of the ulnar, radial and severaldigital arteries and incomplete filling of the palmar arches.

 


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  		Figure 3. 55-year-old female with limited scleroderma who smokes. Pre- and post-angioplasty subtraction images of the left thigh and calf. (a) Pre-angioplasty angiography shows occlusion of the left superficial femoral artery as far as the adductor canal. This was dilated, with a very satisfactory post-angioplasty appearance (b). However, images over the calf (c) show occlusion of two of three calf vessels, with poor collateralformation, the likely explanation for the poor clinical result.

 




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