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Why Would You Have a Temporal Artery Biopsy? Procedure

Temporal artery biopsy (TAB)
Temporal artery biopsy (TAB) is a procedure that involves removing a piece of the temporal artery for examination.

Temporal artery biopsy (TAB) is a procedure that involves removing a piece of the temporal artery for examination under a microscope. The temporal artery is a blood vessel at the temples. This artery is situated close to the skin just before the ears and continues up to the scalp

The doctor will suggest a TAB to check for temporal arteritis. Certain symptoms may raise suspicion for a certain disease and warrant a biopsy. The clinical picture of temporal arteritis is mostly overlapped by symptoms that may mimic other conditions. Therefore, to clear the diagnosis, the doctor may suggest a TAB. There is a high suspicion for temporal arteritis that warrants a biopsy if the patient is older than 50 years of age and has:

  • Claudication (discomfort in the jaw during chewing or after a prolonged speech).
  • Optic disc (optic nerve head) swelling during eye examinations.
  • Recent vision problems.
  • A new or atypical headache or localized head pain.
  • Tenderness, palpation, or reduced pulsation of the artery (blood vessel) on the side of the head.
  • Elevated laboratory inflammatory markers such as erythrocyte sedimentation rate (ESR) by more than 50 mm/h.

The doctor may not suggest a TAB if:

  • The patient has already undergone prolonged treatment with steroidal therapy. After 30 days of steroidal therapy, the diagnostic yield reduces significantly. By contrast, a TAB will remain abnormal for up to 2 weeks after the initiation of steroids.

What is temporal artery arteritis?

Temporal arteritis is an inflammatory disease of the blood vessels that affects medium- and large-sized blood vessels or arteries. It is also known as giant cell arteritis. It usually affects branches of the carotid artery (blood vessels on the side of the neck). Other arteries at any site can be affected as well.

What happens during the TAB procedure?

Before a temporal artery biopsy (TAB),

  • The doctor/surgeon may mark the artery with a surgical pen for at least 5 cm. 
  • The doctor will clip the patient’s hair and scrub and drape the forehead skin properly.
  • The doctor will give local numbing of 5% Lidocaine injection to the patient at the temporal area of their head (at least 1 cm outer side of the artery).

During a TAB,

  • The doctor may try to palpate the patient’s artery if it is difficult to visualize an obscure vessel.
  • They may use a probe to locate the artery based on its pulsations.
  • They will remove at least 2 cm of the artery and seal the artery on both sides with cautery.
  • Finally, they will close the wound with surgical staples or sutures.
  • They will place antibiotic ointment over the wound but will not bandage it.

What are the complications of a TAB?

When performed by a trained physician, a temporal artery biopsy (TAB) is a safe procedure. Rarely, there can be complications such as:

  • Hair loss at the site of incision
  • Widening or gaping of the scar 
  • Foreign body reaction to entrapped hair
  • Non-diagnostic pathological results

Severe complications include:

  • Injury to the facial nerve branches
  • Bleeding
  • Wound infection
  • Hematoma (collection of blood outside of blood vessels)

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