Temporal artery biopsy – How can we improve performance?

IntroductionTemporal arteritis is a rare systemic disease of undefined aetiology. The British Society for Rheumatology has issued evidence-based guidance in the form of an investigative algorithm, central to which is biopsy of the superficial temporal artery (TA). Currently in Glasgow these patients are being referred to the regional vascular unit. We sought to identify areas where local practice could be improved.MethodsThis was a retrospective review of TA biopsy performed since the amalgamation of vascular services in Glasgow.ResultsThere were 32 cases with a complete dataset. The majority of patients referred were women (66%), with a mean age of 68 years (range 43–86 years). A variety of different clinical symptoms were reported. The mean ESR was 53 (range 2–122). The median waiting time from referral to surgical biopsy was 6 days (inter-quartile range 2–8 days). Seven patients waited for more than 14 days for the procedure to be performed. There were four positive biopsies in this case series. TA biopsy influenced the duration of glucocorticosteroid therapy.ConclusionFrom this study we believe that the following changes to local practice would be simple, cost effective and could improve the quality of patient care delivered:
• Patients should be referred to the local rheumatology service for clinical assessment
• TA biopsy does not need to be performed by a vascular specialist and should be performed locally by either the ophthalmology or the local general surgical team on day case, local anaesthesia lists.