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At least 37 records · Page 2Linked to original sources
PubMed2000

Blue toe syndrome: treatment with intra-arterial stents and review of therapies.

PURPOSE: To determine if intra-arterial stent placement can adequately treat lesions producing microemboli to the lower extremities. MATERIALS AND METHODS: During a 6.5-year period, 15 patients presenting with blue toe syndrome had 16 presumed embolic lesions treated with intra-arterial stents. These patients were evaluated during routine clinical follow-up during a 6-month period. This evaluation included physical and noninvasive arterial examinations. When patients could not return for follow-up, hospital, clinical, vascular laboratory, and radiology records were reviewed to assemble the appropriate information. Outcomes included symptoms of recurrent emboli, amputation, and death. RESULTS: Treated embolic lesions included two aortic stenoses, three bilateral iliac artery stenoses, nine unilateral iliac artery stenoses (one patient received separate treatment of unilateral iliac lesions), and two superficial femoral artery stenoses. Patients were followed-up for a mean of 18 months. Eight of 15 patients (53%) were improved or stable without complications. There were eight negative outcomes experienced in seven patients. Three patients (20%) were deceased at follow-up. Four patients (27%) had undergone amputation; one transmetatarsal amputation and three below-the-knee amputations. Only one of these was related to progressive disease in the treated extremity (7%). One patient (7%) experienced recurrent embolic symptoms. Stents were patent in all patients. CONCLUSION: Patients with blue toe syndrome are at high risk of limb loss and mortality despite treatment. Intra-arterial stent placement provides an alternative to standard surgical treatment. Further studies are needed to define the optimum therapy.

Adult↗
PubMed1988

Blue toe syndrome: treatment with anticoagulants and delayed percutaneous transluminal angioplasty.

The spontaneous onset of a painful unilateral blue toe is usually caused by fibrinoplatelet microemboli arising from an upstream stenotic or occlusive lesion of the iliac or femoral artery. This constellation of findings is referred to as the blue toe syndrome (BTS). In 12 patients who experienced 14 spontaneous episodes of BTS, angiography demonstrated 15 proximal atherosclerotic arterial lesions, which were presumed to be the source of the microemboli. Fourteen of the 15 lesions were short-segment stenoses or occlusions distal to the aortic bifurcation. Six lesions were treated with antiplatelet or anticoagulant drugs followed by delayed percutaneous transluminal angioplasty (PTA) 6-12 weeks later. Three lesions were treated with surgical bypass, three with long-term anticoagulation, and one with transcatheter clot aspiration and immediate PTA. Two were treated with immediate thrombolytic therapy and had embolic complications. Antiplatelet and anticoagulant therapy followed by delayed PTA may be an effective alternative to surgery for treating BTS.

Adult↗
PubMed2002

Atheroembolic signals detected by Doppler ultrasound scan monitoring in a patient with blue toe syndrome: report of a case.

It is generally accepted that clinical symptoms give the only clue to the presence of atheroemboli in patients with blue toe syndrome (BTS). We report a case of atheroemboli originating from the abdominal aortic aneurysm in which Doppler ultrasound successfully detected atheroembolic signals, which vanished immediately after surgery. To our knowledge, this is the first such case to be documented. When a 67-year-old man was given warfarin after aortocoronay bypass, digital cyanosis suddenly developed, which became worse and was very painful. Angiography and computed tomography scanning revealed an infrarenal aortic aneurysm with mural thrombus. Doppler ultrasound detected atheroemboli as high-intensity transient signals in the bilateral tibioperoneal trunks. After aneurysmectomy and a bifurcated graft replacement, the cyanotic and painful toes improved immediately. Microscopically, cholesterin crystals were seen in the arterioles of the amputated digits. Thus, Doppler ultrasound could be a valuable test to determine the appropriate treatment for patients at risk of atheroembolic BTS.

Aged↗
PubMed2006

Spontaneous dissection of the popliteal artery in a young man. A rare cause of the blue toe syndrome.

Spontaneous arterial dissection in peripheral arteries of the extremities is an extremely rare event. We report a case of a spontaneous dissection of a nonaneurysmal popliteal artery in an otherwise healthy 36-year-old man that came to clinical attention as an acute blue toe syndrome. The diagnosis was primarily made by high-resolution duplex ultrasound that revealed a dissection flap (length: 15.5 mm; thickness: 0.4 mm) together with the partially thrombosed false lumen at the dorsal wall of the left popliteal artery (degree of local diameter reduction: 56%). Further work-up by means of contrast-enhanced MR-A and conventional DSA confirmed a moderate stenosis of the popliteal artery compatible with focal dissection and excluded other causes such as popliteal artery entrapment syndrome. Under full-dose intravenous anticoagulation with unfractionated heparin that was switched to oral anticoagulation with vitamin K antagonists (target INR: 2-3) and conservative management of the blue toe the patient made a gradual, but eventually complete clinical recovery over 8 weeks.

Adult↗
PubMed2000

Plasma Proteins Case Report: Massive Bone Marrow Necrosis with Polyclonal Hypergammaglobulinemia and Blue Toe Syndrome.

Massive bone marrow necrosis was rare, and most of these cases were accompanied with malignant disease. We report a case that was thought to be idiopathic massive bone marrow necrosis. It was a 58 y.o. male who was admitted because of blue toe syndrome and hypergammaglobulinemia. We tried to detect malignant diseases with computed tomography and gallium scintigraphy, and infectious diseases with bacterial culture and viral antibodies, but all of them were negative. Pancytopenia and bone marrow necrosis was not improved, and he had died after 5-month hospitalization. Autopsy revealed massive bone marrow necrosis and bone marrow fibrosis after necrosis, but malignant or infectious diseases were not detected. It may be diagnosed as idiopathic massive bone marrow necrosis.

Journal Article↗
PubMed1991

Blue toe syndrome.

Taking a precise history from a patient who presents with a "bruised" toe in the absence of trauma requires sharp assessment skills and an investigative nature. Looking beyond the obvious in an otherwise healthy appearing individual calls for knowledge of many different disease processes including blue toe syndrome. Rapid identification, proper diagnosis, and correct medical and nursing management are essential for a positive outcome.

Embolism↗
PubMed1994

External iliac ligation and axillary-bifemoral bypass for blue toe syndrome.

BACKGROUND: This report describes six patients with atheroemboli to both lower extremities that originated from the abdominal aorta. All patients had severe bilateral rest pain and ulceration or gangrene. Each had severe coronary artery disease and other medical problems, which precluded direct aortic reconstruction. METHODS: Ligation of the external iliac arteries was performed to prevent continual passage of emboli into the lower extremities. Revascularization was effected by axillary-bifemoral bypass. RESULTS: Initial limb salvage was accomplished in twelve threatened extremities. One patient required a single toe amputation. One axillary graft failed after 3 months and was successfully replaced with a contralateral graft. These patients have been followed for up to 52 months without limb loss; the mean follow-up is almost 2 1/2 years. CONCLUSIONS: In patients with severe coronary artery disease and blue toe syndrome, the combination of external iliac ligation and axillary-bifemoral bypass is an effective and durable procedure to prevent worsening ischemia and to salvage threatened lower extremities.

Aged↗
PubMed1995

Blue toe syndrome from a "coral reef" aorta.

An endoaortic calcified mass, sometimes referred to as a "coral reef" aorta, is an unusual cause of distal leg microembolization. When discovered it is usually in the suprarenal aorta. We present an unusual case of infrarenal coral reef aorta with symptoms of distal atheroembolism. A review of the literature is also presented.

Aorta, Abdominal↗
PubMed1994

Femoral artery hypoplasia and persistent sciatic artery with blue toe syndrome: a case report, histologic analysis and review of the literature.

When the primitive sciatic artery remains the major artery in the thigh, the superficial femoral artery is usually poorly developed or absent. This abnormal vasculature is ascribed to the persistent embryologic arterial system which can occur unilaterally or bilaterally. Sciatic artery is known to be susceptible to aneurysmal changes. Pulsatile gluteal mass, distal embolization and, lower extremity ischemia in the sitting position are the pathognomonic clinical symptoms. Excision of the sciatic artery combined with femoro-popliteal bypass is the established recommended surgical treatment.

Aneurysm↗
PubMed1983

Blue toe syndrome--a warning sign of unsuspected vascular injury.

A case report is presented of a young patient involved in a motor vehicle accident, who initially demonstrated no physical or radiologic evidence of thoracic injury. Six weeks later the patient was noted to have two blue toes. Arteriography done at that time demonstrated a previously unsuspected false aneurysm of the descending thoracic aorta. An embolic event in a patient with a history of major trauma should be considered a strong indication for arteriographic evaluation of the proximal arterial system.

Adult↗
PubMed1985

The "blue toe" syndrome with renal atheroembolism and failure.

The occurrence of atheromatous embolization following cardiac catheterization and coronary artery bypass surgery is described. It was manifested initially by bluish discolored toes inciting suspicion of vasospasm and then by progressive renal failure. The diagnosis was confirmed by renal biopsy. The syndrome of multiple atheromatous or cholesterol emboli is probably more common than previously reported because of its masquerade of other illnesses and failure of consideration of diagnosis.

Arteriosclerosis↗
PubMed1993

Reversal of gangrenous lesions in the blue toe syndrome with lovastatin--a case report.

A seventy-six-year-old man with ischemic heart disease, peripheral vascular disease, and chronic renal failure developed bilateral cyanotic toes, which upon muscle biopsy, were shown to be caused by atheromatous emboli. The probable source was atheromatosis of the abdominal aorta. The toes became gangrenous, but surgical therapy was deferred because the patient was considered a high risk. With lovastatin therapy there was complete healing and except for transient cyanosis related to temporary cessation of therapy, there has been no recurrence for the past thirty months. The possible role of lovastatin in the conservative treatment of this disorder is discussed.

Aged↗