Cannabis arteritis revisited - Ten new case reports

The purpose of this paper was to revisit the old concept of cannabis arteri tis first described in the 1960s and report 10 new cases. Ten male patients , with a median age of 23.7 years developed subacute distal ischemia of low er or upper limbs, leading to necrosis in the toes and/or fingers and somet imes to distal limb gangrene. Two of the patients also presented with venou s thrombosis and three patients were suffering from a recent Raynaud's phen omenon. Biological test results did not show evidence of the classical vasc ular risk factors for thrombosis. Arteriographic evaluation in all cases re vealed distal abnormalities in the arteries of feet, legs, forearms, and ha nds resembling those of Buerger's disease. A collateral circulation sometim es with opacification of the vasa nervorum was noted. In some cases, arteri al proximal atherosclerotic lesions and venous thrombosis were observed. Al l patients were moderate tobacco smokers and regular cannabis users. Despit e treatment with ilomedine and heparjn in all cases, five amputations were necessary in four patients. The vasoconstrictor effect of cannabis on the v ascular system has been known for a long time. It has been shown that delta -8- and delta-9-tetrahydrocanabinols may induce peripheral vasoconstrictor activity. Cannabis arteritis resembles Buerger's disease, but patients were moderate tobacco smokers and regular cannabis users. These cases show that prolonged use of cannabis could be an additive risk factor for juvenile an d young adult arteritis. Cannabis arteritis is a forgotten and severe occlu sive vascular disease occurring in young adults. Search for cannabis use ma y be an important tool for a better knowledge of arteritis in young smokers .