Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis

Peter C. Grayson, Gunnar Tomasson, David Cuthbertson, Simon Carette, Gary S. Hoffman, Nader A. Khalidi, Carol A. Langford, Carol A. McAlear, Paul A. Monach, Philip Seo, Kenneth J Warrington, Steven R Ytterberg, Peter A. Merkel

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective. To assess the utility of the vascular physical examination to detect arteriographic lesions in patients with established large vessel vasculitis (LVV), including Takayasu's arteritis (TAK) and giant cell arteritis (GCA). Methods. In total, 100 patients (TAK = 68, GCA = 32) underwent standardized physical examination and angiography of the carotid, subclavian, and axillary arteries. Sensitivity and specificity were calculated for the association between findings on physical examination focusing on the vascular system (absent pulse, bruit, and blood pressure difference) and arteriographic lesions defined as stenosis, occlusion, or aneurysm. Results. We found 67% of patients had at least 1 abnormality on physical examination (74% TAK, 53% GCA). Arteriographic lesions were seen in 76% of patients (82% TAK, 63% GCA). Individual physical examination findings had poor sensitivity (range 14%-50%) and good-excellent specificity (range 71%-98%) to detect arteriographic lesions. Even when considering physical examination findings in combination, at least 30% of arteriographic lesions were missed. Specificity improved (range 88%-100%) if individual physical examination findings were compared to a broader region of vessels rather than specific anatomically correlated vessels and if ≥ 1 physical examination findings were combined. Conclusion. In patients with established LVV, physical examination alone is worthwhile to detect arterial disease but does not always localize or reveal the full extent of arteriographic lesions. Abnormal vascular system findings on physical examination are highly associated with the presence of arterial lesions, but normal findings on physical examination do not exclude the possibility of arterial disease. Serial angiographic assessment is advisable to monitor arterial disease in patients with established LVV. The Journal of Rheumatology

Original languageEnglish (US)
Pages (from-to)303-309
Number of pages7
JournalJournal of Rheumatology
Volume39
Issue number2
DOIs
StatePublished - Feb 2012

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Vasculitis
Physical Examination
Blood Vessels
Takayasu Arteritis
Giant Cell Arteritis
Axillary Artery
Blood Pressure
Subclavian Artery
Rheumatology
Carotid Arteries
Aneurysm
Angiography
Pathologic Constriction
Sensitivity and Specificity

Keywords

  • Angiogram
  • Giant cell arteritis
  • Physical examination
  • Takayasu's arteritis
  • Vasculitis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

Grayson, P. C., Tomasson, G., Cuthbertson, D., Carette, S., Hoffman, G. S., Khalidi, N. A., ... Merkel, P. A. (2012). Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis. Journal of Rheumatology, 39(2), 303-309. https://doi.org/10.3899/jrheum.110652

Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis. / Grayson, Peter C.; Tomasson, Gunnar; Cuthbertson, David; Carette, Simon; Hoffman, Gary S.; Khalidi, Nader A.; Langford, Carol A.; McAlear, Carol A.; Monach, Paul A.; Seo, Philip; Warrington, Kenneth J; Ytterberg, Steven R; Merkel, Peter A.

In: Journal of Rheumatology, Vol. 39, No. 2, 02.2012, p. 303-309.

Research output: Contribution to journalArticle

Grayson, PC, Tomasson, G, Cuthbertson, D, Carette, S, Hoffman, GS, Khalidi, NA, Langford, CA, McAlear, CA, Monach, PA, Seo, P, Warrington, KJ, Ytterberg, SR & Merkel, PA 2012, 'Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis', Journal of Rheumatology, vol. 39, no. 2, pp. 303-309. https://doi.org/10.3899/jrheum.110652
Grayson, Peter C. ; Tomasson, Gunnar ; Cuthbertson, David ; Carette, Simon ; Hoffman, Gary S. ; Khalidi, Nader A. ; Langford, Carol A. ; McAlear, Carol A. ; Monach, Paul A. ; Seo, Philip ; Warrington, Kenneth J ; Ytterberg, Steven R ; Merkel, Peter A. / Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis. In: Journal of Rheumatology. 2012 ; Vol. 39, No. 2. pp. 303-309.
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abstract = "Objective. To assess the utility of the vascular physical examination to detect arteriographic lesions in patients with established large vessel vasculitis (LVV), including Takayasu's arteritis (TAK) and giant cell arteritis (GCA). Methods. In total, 100 patients (TAK = 68, GCA = 32) underwent standardized physical examination and angiography of the carotid, subclavian, and axillary arteries. Sensitivity and specificity were calculated for the association between findings on physical examination focusing on the vascular system (absent pulse, bruit, and blood pressure difference) and arteriographic lesions defined as stenosis, occlusion, or aneurysm. Results. We found 67{\%} of patients had at least 1 abnormality on physical examination (74{\%} TAK, 53{\%} GCA). Arteriographic lesions were seen in 76{\%} of patients (82{\%} TAK, 63{\%} GCA). Individual physical examination findings had poor sensitivity (range 14{\%}-50{\%}) and good-excellent specificity (range 71{\%}-98{\%}) to detect arteriographic lesions. Even when considering physical examination findings in combination, at least 30{\%} of arteriographic lesions were missed. Specificity improved (range 88{\%}-100{\%}) if individual physical examination findings were compared to a broader region of vessels rather than specific anatomically correlated vessels and if ≥ 1 physical examination findings were combined. Conclusion. In patients with established LVV, physical examination alone is worthwhile to detect arterial disease but does not always localize or reveal the full extent of arteriographic lesions. Abnormal vascular system findings on physical examination are highly associated with the presence of arterial lesions, but normal findings on physical examination do not exclude the possibility of arterial disease. Serial angiographic assessment is advisable to monitor arterial disease in patients with established LVV. The Journal of Rheumatology",
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AU - Hoffman, Gary S.

AU - Khalidi, Nader A.

AU - Langford, Carol A.

AU - McAlear, Carol A.

AU - Monach, Paul A.

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AU - Warrington, Kenneth J

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N2 - Objective. To assess the utility of the vascular physical examination to detect arteriographic lesions in patients with established large vessel vasculitis (LVV), including Takayasu's arteritis (TAK) and giant cell arteritis (GCA). Methods. In total, 100 patients (TAK = 68, GCA = 32) underwent standardized physical examination and angiography of the carotid, subclavian, and axillary arteries. Sensitivity and specificity were calculated for the association between findings on physical examination focusing on the vascular system (absent pulse, bruit, and blood pressure difference) and arteriographic lesions defined as stenosis, occlusion, or aneurysm. Results. We found 67% of patients had at least 1 abnormality on physical examination (74% TAK, 53% GCA). Arteriographic lesions were seen in 76% of patients (82% TAK, 63% GCA). Individual physical examination findings had poor sensitivity (range 14%-50%) and good-excellent specificity (range 71%-98%) to detect arteriographic lesions. Even when considering physical examination findings in combination, at least 30% of arteriographic lesions were missed. Specificity improved (range 88%-100%) if individual physical examination findings were compared to a broader region of vessels rather than specific anatomically correlated vessels and if ≥ 1 physical examination findings were combined. Conclusion. In patients with established LVV, physical examination alone is worthwhile to detect arterial disease but does not always localize or reveal the full extent of arteriographic lesions. Abnormal vascular system findings on physical examination are highly associated with the presence of arterial lesions, but normal findings on physical examination do not exclude the possibility of arterial disease. Serial angiographic assessment is advisable to monitor arterial disease in patients with established LVV. The Journal of Rheumatology

AB - Objective. To assess the utility of the vascular physical examination to detect arteriographic lesions in patients with established large vessel vasculitis (LVV), including Takayasu's arteritis (TAK) and giant cell arteritis (GCA). Methods. In total, 100 patients (TAK = 68, GCA = 32) underwent standardized physical examination and angiography of the carotid, subclavian, and axillary arteries. Sensitivity and specificity were calculated for the association between findings on physical examination focusing on the vascular system (absent pulse, bruit, and blood pressure difference) and arteriographic lesions defined as stenosis, occlusion, or aneurysm. Results. We found 67% of patients had at least 1 abnormality on physical examination (74% TAK, 53% GCA). Arteriographic lesions were seen in 76% of patients (82% TAK, 63% GCA). Individual physical examination findings had poor sensitivity (range 14%-50%) and good-excellent specificity (range 71%-98%) to detect arteriographic lesions. Even when considering physical examination findings in combination, at least 30% of arteriographic lesions were missed. Specificity improved (range 88%-100%) if individual physical examination findings were compared to a broader region of vessels rather than specific anatomically correlated vessels and if ≥ 1 physical examination findings were combined. Conclusion. In patients with established LVV, physical examination alone is worthwhile to detect arterial disease but does not always localize or reveal the full extent of arteriographic lesions. Abnormal vascular system findings on physical examination are highly associated with the presence of arterial lesions, but normal findings on physical examination do not exclude the possibility of arterial disease. Serial angiographic assessment is advisable to monitor arterial disease in patients with established LVV. The Journal of Rheumatology

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