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Home > Journals > Italian Journal of Vascular and Endovascular Surgery > Past Issues > Giornale Italiano di Chirurgia Vascolare 2000 September;7(3) > Giornale Italiano di Chirurgia Vascolare 2000 September;7(3):225-31



A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
Indexed/Abstracted in: EMBASE, Scopus

Frequency: Quarterly

ISSN 1824-4777

Online ISSN 1827-1847


Giornale Italiano di Chirurgia Vascolare 2000 September;7(3):225-31


Mixed idiopathic cryoglobulinemic vasculitis. A case report

Schiavetta A., Falchero M. *, Bagliani A. **, Rovani G., Patrone P.

From the Division of Vascular Surgery
* Division of Medicine Azienda Ospedaliera S. Corona, Pietra Ligure, Savona, Italy
** Department of Angiology, Pavia University, Pavia, Italy 

Vasculites ­play a par­tic­u­lar­ly impor­tant ­role for the vas­cu­lar sur­geon in ­that ­they are rel­a­tive­ly ­rare, mul­ti­form pathol­o­gies ­that are not ­easy to diag­nose and ­treat. A 67-­year-old man was ­referred to our atten­tion ­with a his­to­ry of ingra­ves­cent ischem­ic phe­nom­e­na affect­ing the ­four ­limbs, ­already com­pli­cat­ed by irre­ver­sible dig­i­tal par­cel­lar ­lesions. The clin­i­cal sit­u­a­tion ­evolved dur­ing hos­pi­tal­isa­tion ­with the ­onset of pete­chia on the low­er ­limbs. Hematochemical ­tests ­showed the pres­ence of an ongo­ing auto­im­mune pro­cess ­with evi­dence of cir­cu­lat­ing cryo­glob­u­lins. A diag­no­sis was ­made of ­mixed idiopath­ic cryog­lo­bu­li­nem­ic vas­cu­litis, ­because no caus­es ­were iden­ti­fied ­that ­could ­have attrib­ut­ed the phe­nom­e­non to a sec­on­dary man­i­fes­ta­tion of ­another dis­ease. Scaled treat­ment ­with cyclo­phos­pha­mide and pred­ni­sone result­ed in a grad­u­al nor­mal­isa­tion of hemat­o­chem­i­cal param­e­ters. The asso­ci­a­tion of immu­no­sup­pres­sive and vasoac­tive med­i­cal treat­ment and sur­gery (bilat­er­al lum­bar gan­gli­o­nec­to­my and ­right cer­vi­coth­o­rac­ic gan­gli­o­nec­to­my) led to a con­sid­er­able improve­ment in the objec­tive and sub­jec­tive pic­ture.
Vasculites can be clas­si­fied ­into ­large ­groups in ­which ­each nos­o­log­i­cal ­entity ­presents par­tic­u­lar char­ac­ter­is­tics. Unfortunately, sev­er­al cas­es ­present “­false” symp­toms ­with ­mixed char­ac­ter­is­tics. In ­these sit­u­a­tions, the diag­no­sis and treat­ment are ­more com­plex and the evo­lu­tion of the dis­ease is ­more errat­ic. It is advis­able to use a mul­ti­dis­ci­pli­nary ­approach in ­order to ­obtain bet­ter ­results.
The ­vast sec­tor of vas­cu­litis ­awaits fur­ther ­study to ­allow the vas­cu­lar sur­geon to ­adopt a ­more effi­cient ­approach in a ­field ­where ­much has ­been ­achieved, but ­much ­still ­remains to be ­done.

language: English, Italian


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