No abstract available.
Blue Toe Syndrome* ; Disseminated Intravascular Coagulation*

Aged ; Blue Toe Syndrome ; complications ; diagnosis ; Humans ; Kidney Failure, Chronic ; etiology ; Male

Blue toe syndrome is characterized by tissue ischemia secondary to cholesterol crystal or atherothrombotic embolization. It leads to the occlusion of small vessels. The treatment option is usually surgery for most causes of blue toe syndrome. However, endovascular aortic repair by aorto-iliac stent graft become more and more popular because of its effectiveness and its less invasive characteristic. We present a 57-year-old man who suffered from blue toes syndrome on both legs caused by embolizing aorto-iliac lesions. Successful Endurant stent graft (Medtronic Vascular, Santa Rosa, CA, USA) was performed on infrarenal abdominal aorta and on proximal portion of right and left common iliac artery.
Aorta, Abdominal ; Blood Vessel Prosthesis ; Blue Toe Syndrome* ; Cholesterol ; Humans ; Iliac Artery ; Ischemia ; Leg ; Middle Aged ; Rosa ; Thromboembolism ; Toes

Aged ; Atherosclerosis ; complications ; Blue Toe Syndrome ; diagnosis ; etiology ; metabolism ; pathology ; Cell Nucleus ; Cholesterol ; blood ; Color ; Epidermis ; Female ; Humans ; Male

Antiphospholipid syndrome (APS) is an acquired systemic autoimmune disorder characterized by a combination of clinical criteria, including vascular thrombosis or pregnancy morbidity and elevated antiphospholipid antibody titers. It is one of the causes of deep vein thrombosis and pulmonary embolism that can be critical due to the mortality risk. Overall recurrence of thromboembolism is very low with adequate anticoagulation prophylaxis. The most effective treatment to prevent recurrent thrombosis is long-term anticoagulation. We report on a 17-year-old male with APS, who manifested blue toe syndrome, deep vein thrombosis, pulmonary thromboembolism, and cerebral infarction despite adequate long-term anticoagulation therapy.
Adolescent ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Blue Toe Syndrome ; Cerebral Infarction ; Cerebrovascular Disorders ; Embolism* ; Humans ; Male ; Mortality ; Pregnancy ; Pulmonary Embolism ; Recurrence ; Thromboembolism ; Thrombosis ; Veins* ; Venous Thrombosis

Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE), which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.
Acute Kidney Injury* ; Amputation ; Biopsy ; Blue Toe Syndrome* ; Cholesterol* ; Embolism, Cholesterol ; Gangrene ; Humans ; Ischemia ; Lower Extremity ; Narcotics ; Risk Factors ; Sympathectomy* ; Toes

PURPOSE: To evaluate the results of iliac artery angioplasty and stent placement as an option for the treatment of aortoiliac occlusive disease. METHOD: The records of 30 patients (mean age, 65.5 years) who underwent iliac artery angioplasty and/or stent placement were reviewed retrospectively. Presenting symptoms included asymptomatic (6.7%), claudication (73.3%), rest pain (10%), ulceration/tissue loss (3.3%), and blue toe syndrome (6.7%). Follow-up included angioplasty, Doppler ultrasound, and clinical examination. Mean follow-up time was 32 months. RESULT: Forty iliac lesions were treated. Thirty-seven percent of patients had hypertension, 33% had diabetes mellitus, 23% had coronary arterial disease, 6.6% had cerebrovascular disease, 3.3% had hyperlipidemia and 3.3% had renal insufficiency. TASC (Trans Atlantic Inter-Society Consensus) A, B, C and D disease types were 11 (36.7%) patients, 5 (16.7%), 10 (33.3%) and 4 (13.3%). Ipsilateral superficial femoral artery occlusion was present in 6 (20%) patients. Concomitant femoral artery bypass surgery was performed in 10 (33.3%) patients. The cumulative primary patency rates were 83.4%, 71.9% and 64.7% at 1, 2, and 3 years, respectively. CONCLUSION: Iliac artery angioplasty and stent placement is a technically safe and effective treatment modality in patients without ipsilateral superficial femoral artery occlusion.
Angioplasty* ; Blue Toe Syndrome ; Diabetes Mellitus ; Femoral Artery ; Follow-Up Studies ; Humans ; Hyperlipidemias ; Hypertension ; Iliac Artery ; Renal Insufficiency ; Retrospective Studies ; Stents* ; Ultrasonography

PURPOSE: Blue toe syndrome consists of blue or purplish toes in the absence of a history of obvious trauma, serious cold exposure, or disorders producing generalized cyanosis. It is a life-threatening and still underrecognized disease. It can be commonly occurred by vascular surgery, invasive cutaneous procedures or anticoagulant therapy. Our case is presented of blue toe syndrome related to atheromatous embolization that was presumably triggered by angio CT. METHODS: A 69-year-old man presented with the suddenly developed pain, cyanosis and livedo reticularis of the toes in right foot. Dorsalis pedis pulses were palpable. He had been performed a diagnostic angio CT 1 month earlier. Angio CT revealed diffuse aortic atheromatous plaque in lower abdominal aorta and both common iliac artery. One month after angio CT, he visited our clinic. There was no visible distal first dorsal metatarsal artery and digital artery of right first toe in lower extremity arteriography. A diagnosis was established of blue toe syndrome. Because his symptom was aggravated, we performed the exploration of the right foot. After exposure of first dorsal metatarsal artery, microsurgical atheroembolectomy was done. RESULTS: There were no postoperative complications. After three months the patient had no clinically demonstrable problems. CONCLUSION: Patient with blue toe syndrome is at high risk of limb loss and mortality despite treatment. Blue toe syndrome produces painful, cyanosed toes with preserved pedal pulses. It needs to be aware of blue toe syndrome. Careful history should reveal the diagnosis. Treatment is controversial, however, most believe that anticoagulation therapy should be avoided.
Aged ; Angiography ; Aorta, Abdominal ; Arteries ; Blue Toe Syndrome ; Cold Temperature ; Cyanosis ; Extremities ; Foot ; Humans ; Iliac Artery ; Livedo Reticularis ; Lower Extremity ; Metatarsal Bones ; Postoperative Complications ; Toes

Blue toe syndrome involves blue or purplish toes in the absence of trauma, serious cold exposure, or disorders causing general cyanosis. Clinical presentation can range from a cyanotic toe to a diffuse, multi-organ systemic disease. A 75-year-old man presented with claudication, sudden bilateral painful discoloration of the sole, blue-colored toes, and anuria. Three weeks earlier, he had been diagnosed with acute myocardial infarction and had undergone catheterization for percutaneous coronary intervention. Histopathologic findings showed vascular ectasia with mild perivascular inflammation. Based on patient history, physical examination, and laboratory findings, he was diagnosed with blue toe syndrome. Our patient presented with clinical manifestations, including peripheral cutaneous involvement and acute deterioration of renal function. This case highlights the importance of prompt diagnosis of blue toe syndrome by careful history-taking and physical examination in order to avoid multi-organ systemic disease.
Aged ; Anuria ; Blue Toe Syndrome* ; Catheterization ; Catheters ; Cyanosis ; Diagnosis ; Dilatation, Pathologic ; Embolism, Cholesterol ; Humans ; Inflammation ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Physical Examination ; Toes

PURPOSE: Endovascular repair is a alternative treatment with favorable short-term result, but long term results are not available compared to standard operation. The authors have reviewed experiences of Asan Medical Center on stented graft, performed from Aug. 1998 to Feb. 2000, and the results as to age, operative indication, clinical condition, anatomic location, complication, follow-up are reported. METHOD: Seven patients who has received stented graft between Aug. 1998 and Feb. 2000 are reviewed retrospectively. RESULT: Of the seven patients, 6 were male and 1 was female. The mean age was 46.4 years (17~71). Indication for stented graft were two pseudoaneurysms, two iatrogenic arterio-venous fistulas, one thoracic aorta aneurysm, one abdominal aortic aneurysm, and one iliac artery occlusion with blue toe syndrome. Three different types of stented graft devices were utilized: Dacron-covered nitinol stented graft (made by the Asan Medical Center medical device team), Vanguard II (by Boston Scientific Corp.), and PTFE with nitinol stented graft (by Tae-woong). There was no perioperative mortality, and the technical success was achieved in five cases (71%). The patency at 14-month were 100% (5/5). Two immediate complications are hemorrhage due to iliac & femoral artery avulsion requiring emergency bypass grafting, and deployment failure of stented graft requiring removal of retained graft device. CONCLLUSION: Stented graft may be utilized even in complicated vascular situation but will need further development of device and more experience to prevent possible catastrophic complication. Indication should be decided by team approach and vascular surgeon should be prevent or participate during the procedure.
Aneurysm ; Aneurysm, False ; Aorta, Thoracic ; Aortic Aneurysm, Abdominal ; Blue Toe Syndrome ; Chungcheongnam-do ; Emergencies ; Female ; Femoral Artery ; Fistula ; Follow-Up Studies ; Hemorrhage ; Humans ; Iliac Artery ; Male ; Mortality ; Polytetrafluoroethylene ; Retrospective Studies ; Stents* ; Transplants*