Distinctive arterial collaterals caused by aortic occlusion in a patient with antiphospholipid syndrome

Article information

Korean J Intern Med. 2021;36(5):1258-1259

Publication date (electronic) : 2020 June 17

doi : https://doi.org/10.3904/kjim.2020.041

Shunya Kaneshita^1,2, Masei Suda², Masato Okada²

¹Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

²ImmunoRheumatology Center, St. Luke’s International Hospital, St. Luke’s International University, Tokyo, Japan

Correspondence to Shunya Kaneshita, M.D. Tel: +81-75-251-5505 Fax: +81-75-252-3721 E-mail: shunya-k@koto.kpu-m.ac.jp

Received 2020 February 4; Revised 2020 February 4; Accepted 2020 April 2.

A 41-year-old Japanese female smoker (20-pack-year) presented with a history of thrombocytopenia, aortic occlusion, and chronic kidney disease due to antiphospholipid syndrome (APS). She was diagnosed with APS on the basis of thrombosis and persistently tested positive for lupus anticoagulant diluted Russell’s viper venom time test (initial-visit:follow-up after 3 months, 2.1:1.6), high-titer anticardiolipin antibody (≥ 120:104 U/mL), and high-titer anti-beta2-glycoprotein-I antibody (≥ 125:83.3 U/mL). She was treated with low-dose aspirin, warfarin, prednisolone 5 mg/day, and hydroxychloroquine 300 mg/day.

She also reported intermittent claudication lasting several months, and her ankle brachial index (ABI) was 0.56/0.67 (right/left). Whole trunk contrast-enhanced computed tomography revealed a complete occlusion of the infrarenal aorta with thrombosis (length = 50 mm) (Fig. 1A). Numerous vascular collaterals had developed, especially from the subclavian arteries to the femoral arteries on both sides (Fig. 1B and 1C). The patient remained on low-dose aspirin and warfarin, as the circulation in the lower legs was apparently maintained by these collateral arteries. Under close observation, the intermittent claudication gradually subsided and the ABI of the right leg improved to 0.69 upon repeated testing.

Figure 1.

Three-dimensional contrast-enhanced computed tomography of the whole trunk. (A) Complete occlusion of the infrarenal aorta. (B, C) Numerous vascular collaterals and collateral arteries from the subclavian arteries to the femoral arteries on both sides (arrows).

Arterial thrombosis is a common symptom among patients with APS; the thrombosis can occur at various sites such as the cerebral, renal, mesenteric, and lower limb arteries. Although emergency treatment is required in the case of acute thrombosis in these regions, it is possible that the blood flow is maintained through collateral artery development in cases of chronic thrombosis. In such cases, the thrombosis can be managed with conservative treatment.

The patient gave written informed consent to publish the material.