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

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

No abstract available.
Acute Kidney Injury* ; Cholesterol* ; Coronary Angiography* ; Embolism, Cholesterol*

Cholesterol crystal embolism caused by showers of cholesterol emboli from an atherosclerotic aorta is a multisystem disorder that affects many organs. Common signs and symptoms on presentation include skin findings and renal failure. However, myositis due to a cholesterol embolism is uncommon. We report a rare case of cholesterol crystal embolism that presented with features of focal and foot necrosis in an 83-year-old woman.
Aorta ; Cholesterol ; Embolism ; Embolism, Cholesterol ; Female ; Foot ; Humans ; Myositis ; Necrosis ; Renal Insufficiency ; Skin

Cholesterol embolization syndrome (CES) usually occurs after endovascular procedures, it may also occurs after using anticoagulants and thrombolytics. We report a case of 66-year-old man with sudden elevation of creatinine after using warfarin due to cortical infarction. Histologic examinations revealed a cholesterol cleft on the arcuate artery. We concluded it as warfarin induced atheroembolic renal disease. Careful observation of kidneys is necessary in the case of renal abnormalities after using anticoagulation, considering the possibility of cholesterol embolism due to anticoagulant therapy.
Aged ; Anticoagulants ; Arteries ; Cholesterol ; Creatinine ; Embolism ; Embolism, Cholesterol ; Endovascular Procedures ; Humans ; Infarction ; Kidney ; Warfarin

Blue digit syndrome, peripheral atheroembolism, and atheromatous embolization, all refer to microembolization and occlusion of the smaller distal arteries. Despite the longstanding recognition that atheroemboli arise from severely degenerative atherosclerotic plaques in the proximal circulation, many questions remain about the pathophysiology and natural history of this disorder. The threat to the survival of a single digit may not appear to be of great consequence, but repeated episodes of atheroembolism with continued destruction of the collateral circulation may portend disaster for the digit. Diagnostic efforts should be promptly concentrated on the location, stabilization and preferably, eradication of the embolic source. We report 2 cases of blue digit syndrome were managed by endarterectomy and intra-arterial stenting. Case 1: A 61-year-old man was presented with the blue toe syndrome at the third, fourth, fifth toes. The bilateral pedal pulses were normally palpable and ankle-brachial pressure indices (ABI) were within normal range. At the findings of duplex ultrasonography and CT angiography, right common femoral artery showed a focal eccentric stenosis with mural thrombus. The right common femoral artery endarterectomy was performed for the athersclerotic ulcerating plaque. Case 2: A 64-year-old man was presented with 11-month history of his left leg pain and 1-week history of his left third, fourth fingers. He had a history of flap operation for his left fourth finger tip due to necrosis. At the findings of angiography, multiple stenosis of left common iliac and left subclavian arteries were found. The lesion of left subclavian artery lesion was presumed to be the source of blue finger syndrome and treated with intra-arterial stent placement after balloon angioplasty.
Angiography ; Angioplasty, Balloon ; Arteries ; Blue Toe Syndrome ; Collateral Circulation ; Constriction, Pathologic ; Disasters ; Embolism, Cholesterol ; Endarterectomy* ; Femoral Artery ; Fingers ; Humans ; Leg ; Middle Aged ; Natural History ; Necrosis ; Plaque, Atherosclerotic ; Reference Values ; Stents* ; Subclavian Artery ; Thrombosis ; Toes ; Ulcer ; Ultrasonography

PURPOSE: Many articles have proposed that osteonecrosis of the femoral head (ONFH) is caused by fat embolism or intravascular coagulation linked to hyperlipidemia. To determine whether hyperlipidemia is an associated factor for ONFH, serum lipid levels were measured. MATERIALS AND METHODS: Nighty-eight patients presenting with ONFH and 110 controls were investigated. We compared the average value of serum lipid levels and the incidence of hyperlipidemia of the two groups. RESULTS: ONFH group showed generalized increase in lipid level and statistically significant difference in the average value of total cholesterol (P=0.0001), HDL-cholesterol (P=0.0261) and phospholipid (P=0.0465) compared with the control. The incidence of hyperlipidemia of the two groups showed statistically significant difference in HDL-cholesterol (P=0.019) and triglyceride (P=0.024). CONCLUSION: Hyperlipidemia seems to be associated with pathogenesis of ONFH. We speculated that hyperlipidemia might be a contributing factor of ONFH. Hyperlipidemia may play a role as a triggering factor in the pathogenetic process that results in osteonecrosis. However, it can not be ruled out that secondary hyperlipidemia might be a finding following ONFH.
Cholesterol ; Embolism, Fat ; Head* ; Humans ; Hyperlipidemias ; Incidence ; Osteonecrosis* ; Triglycerides

Cholesterol embolism is due to dislodgment of cholesterol crystals from the atheromatous aorta resulting in an occlusion of small arteries. Cholesterol emboli may occur spontaneously but usually develops as a complication of vascular procedures. The organs most frequently involved are the skin and the kidneys but any organ can be affected. Cutaneous manifestations include livedo reticularis, indurated firm violaceous painful plaques and noduli tending to show central necrosis and tender blue toes. We report two cases of cutaneous cholesterol embolization of lower extremities with the impairment of renal function after coronary angiography, proven by skin biopsy.
Aorta ; Arteries ; Biopsy* ; Cholesterol* ; Coronary Angiography* ; Embolism ; Embolism, Cholesterol* ; Kidney ; Livedo Reticularis ; Lower Extremity ; Necrosis ; Skin* ; Toes

PURPOSE:We investigated the incidence and predisposing factors of pulmonary embolism in minimal change nephrotic syndrome(MCNS). METHODS:Lung perfusion scan using 99mTC-MAA were done on 14 patients who were diagnosed to minimal change nephrotic syndrome. Group A; Five patients who had perfusion defects on scan, Group B; Nine patients who had no perfusion defect on scan. Between the two groups, the differences of platelet number, hematocrits, albumin, cholesterol, triglyceride, proteinuria were evaluated. RESULTS:Five patients were found to have perfusion defect consistent with pulmonary embolism(35.7%). However, there were minimal or no respiratory symptoms and signs. In our laboratory studies, the mean proteinuria on admissions was 676+/-31 mg/m2/hr in the group with pulmonary embolism, and 313+/-28 mg/m2/hr in the group without pulmonary embolism. There were more severe proteinuria in group with pulmonary embolism(P<0.05). The mean platelet count at early stage of remission after steroid treatment was 746,600+/-280,000/mm3 in the group with pulmonary embolism, 511,890+/-90,000/mm3 in the group without pulmonary embolism. There were significant difference of platelet count between the two groups(P<0.01). In patients with pulmonary embolism, there were more higher and sustained increasement of platelet count. All cases of pulmonary embolism were treated with dipyridamole(5 mg/kg). In 4 cases the perfusion defects were improved in two weeks, however, one case showed persistent perfusion defect after 1 month. CONCLUSION:Our study suggested that pulmonry embolism might be one of the major complications in childhood MCNS. The occurrence rate was correlated with severity of proteinuria before treatment and sustained increasement of platelet counts in early remission state after steroid treatment. Therefore, the scintigraphic pulmonary perfusion study is mandatory in childhood MCNS, especially in the high risk patients, such as the patients with severe proteinuria and sustained increasement of platelet count.
Causality ; Cholesterol ; Embolism ; Hematocrit ; Humans ; Incidence ; Nephrosis, Lipoid* ; Perfusion ; Platelet Count ; Proteinuria ; Pulmonary Embolism* ; Triglycerides

A cholesterol embolism is a systemic disease resulting from the occlusion of arteries by cholesterol crystals released from atheromatous plaques. It has been associated with inflammation, sheering forces from blood flow due to hypertension, aneurysm formation, infection, mechanical manipulation during surgery or vascular procedures, and anticoagulation. We report a case of a cutaneous cholesterol embolism in a 66-year old man who had purpuric skin lesions on both feet associated with diabetes mellitus, hypertension, and anticoagulation for a cerebral infarction.
Aneurysm ; Arteries ; Cerebral Infarction ; Cholesterol ; Diabetes Mellitus ; Embolism, Cholesterol ; Foot ; Hypertension ; Inflammation ; Plaque, Atherosclerotic ; Skin