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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2000 September;7(3):225-31
language: English, Italian
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.