Temporal artery biopsy technique
- Palma Shaw, MD
Palma Shaw, MD
- Associate Professor of Surgery
- Upstate Medical University
- Section Editors
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Sciences Center - Dallas Campus
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
- Eric L Matteson, MD, MPH
Eric L Matteson, MD, MPH
- Section Editor — Treatment Issues in Rheumatology
- Chair, Division of Rheumatology
- Professor of Medicine
- Mayo Clinic College of Medicine
Temporal artery biopsy is the primary modality for establishing a diagnosis of giant cell (temporal) arteritis. Giant cell arteritis is a chronic vasculitis affecting medium and large diameter arteries, predominantly in older individuals [1,2]. The aortic arch vessels and branches, and particularly branches of the external carotid artery, are most prominently affected . The clinical manifestations result from inflammation of the affected arteries or from their gradual occlusion leading to signs of arterial ischemia [4,5].
The technical aspects of arterial biopsy by which to confirm a diagnosis of giant cell arteritis are reviewed here. The pathogenesis, clinical manifestations, diagnostic evaluation, and treatment of giant cell arteritis are reviewed elsewhere. (See "Pathogenesis of giant cell (temporal) arteritis" and "Clinical manifestations of giant cell (temporal) arteritis" and "Diagnosis of giant cell (temporal) arteritis" and "Treatment of giant cell (temporal) arteritis".)
INDICATIONS FOR BIOPSY
Temporal artery biopsy, which identifies the characteristic histopathology, remains the primary modality to diagnose giant cell (temporal) arteritis [6,7]. Other modalities used in the diagnosis of giant cell arteritis are discussed in detail elsewhere. (See "Diagnosis of giant cell (temporal) arteritis".)
The operating surgeon should be aware that the clinical manifestations of giant cell arteritis may overlap with those of polymyalgia rheumatica and both disease processes occur in similar patient populations . If there is any question regarding the need for biopsy, the operating surgeon should consult the referring physician. The clinical manifestations of giant cell (temporal) arteritis are reviewed elsewhere. (See "Clinical manifestations of giant cell (temporal) arteritis".)
Temporal artery biopsy is generally a straightforward procedure typically performed using local anesthetic with few complications. As such, there are no absolute contraindications.
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- INDICATIONS FOR BIOPSY
- GLUCOCORTICOID THERAPY AND TIMING OF BIOPSY
- Superficial temporal artery
- Other cranial arteries
- PATIENT PREPARATION
- Antibiotic prophylaxis
- BIOPSY PROCEDURE
- Site selection
- - Superficial temporal artery
- Unilateral versus bilateral biopsy
- - Other biopsy sites
- Materials and equipment
- Patient positioning and skin preparation
- Biopsy technique
- - Specimen length
- Alternative biopsy sites
- Specimen handling
- FOLLOW-UP INSTRUCTIONS AND CARE
- NEED FOR REPEAT BIOPSY
- Nerve injury
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS