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Alwattar-Ceballos O, Martínez-Montalvo L, Montero-García M, Gómez-Manzanares M, Arambarri-Segura M. Blue toe syndrome due to crystal cholesterol embolism. Med Clin (Barc) 2024; 162:407. [PMID: 38042736 DOI: 10.1016/j.medcli.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Omar Alwattar-Ceballos
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - Laura Martínez-Montalvo
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Marina Montero-García
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Mónica Gómez-Manzanares
- Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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2
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Suzuki M, Watari T. Blue toe syndrome caused by spontaneous cholesterol embolization syndrome. QJM 2023; 116:936-937. [PMID: 37471693 DOI: 10.1093/qjmed/hcad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- M Suzuki
- Department of General Internal Medicine, National Hospital Organization Sendai Medical Center, Miyagi, Japan
| | - T Watari
- Department of Internal Medicine, University of Michigan Medical School, MI, USA
- General Medicine Centre, Shimane University Hospital, Shimane, Japan
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3
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Kano Y, Shigehara Y. Blue toe syndrome caused by cholesterol crystal embolisation in a patient with warfarin use. BMJ Case Rep 2023; 16:e257927. [PMID: 37798039 PMCID: PMC10565294 DOI: 10.1136/bcr-2023-257927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Affiliation(s)
- Yasuhiro Kano
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yohya Shigehara
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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4
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Casado-Hoces SV, González-Tejedor D, Domínguez-García MA, Reina-Herraiz B. Blue toe syndrome. Rev Esp Sanid Penit 2023; 25:122-124. [PMID: 38289167 PMCID: PMC10910321 DOI: 10.18176/resp.00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Sofía Victoria Casado-Hoces
- Specialist Nurse in Family and Community Medicine. Madrid III-Valdemoro Prison.Madrid III-Valdemoro PrisonSpain
| | - Delia González-Tejedor
- Specialist Physician in in Family and Community Medicine. Specialist in Psychiatry at the Madrid III-Valdemoro Prison.Madrid III-Valdemoro PrisonSpain
| | | | - Beatriz Reina-Herraiz
- Nurse and Podiatrist at the Madrid III-Valdemoro Prison.Madrid III-Valdemoro PrisonSpain
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5
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Mosquera Rey V, Palomo Antequer C, Cienfuegos Basanta C, Zanabili Al-Sibbai A, Fidalgo Navarro A, Alonso Pérez M. [Blue toe syndrome as a clinical finding of pheochromocytoma]. Medicina (B Aires) 2018; 78:368-371. [PMID: 30285931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Pheochromocytomas are tumors that arise from chromaffin cells of the sympathetic nervous system and act by synthesizing and releasing catecholamines. They usually occur between the fourth and fifth decade of life and have a very wide clinical presentation. They occur only in 0.1-0.2% of the hypertensive population and represent a treatable and curable cause of arterial hypertension, as well as other symptoms derived from the uncontrolled secretion of catecholamines. Peripheral arterial ischemia secondary to massive amines release by a pheochromocytoma is a very uncommon condition. Here we report a case of pheochromocytoma manifested as blue finger syndrome in a patient with palpable distal pulses and history of poor blood pressure control despite treatment with two drugs.
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Affiliation(s)
- Vicente Mosquera Rey
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Central de Asturias (HUCA), Oviedo, España. E-mail:
| | - Carmen Palomo Antequer
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias (HUCA), Oviedo, España
| | | | - Amer Zanabili Al-Sibbai
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Central de Asturias (HUCA), Oviedo, España
| | - Alba Fidalgo Navarro
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias (HUCA), Oviedo, España
| | - Manuel Alonso Pérez
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Central de Asturias (HUCA), Oviedo, España
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6
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Sousa Pinto C, Vidoedo JC, Almeida Pinto J, Vasconcelos J, Maia M, Cruz A, Neves E. [Benign Presentation of a Potentially Fatal Disease]. Rev Port Cir Cardiotorac Vasc 2018; 25:77-82. [PMID: 30317716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 06/08/2023]
Abstract
Atheroembolism is a rare multisystemic disorder that is characterized by release of cholesterol crystals and particles from atheromatous plaques, which can occlude distal vessels and induce an inflammatory response. Most affected individuals are males, older than 60 years of age, with advanced atherosclerotic disease. The abdominal aorta is the most common origin of cholesterol emboli, being the peripheral arteries a rarer source. Cholesterol embolization syndrome is often associated with invasive vascular procedures, although, more rarely, it may occur spontaneously. In this paper, the authors present three cases of spontaneous atheroembolism with cutaneous manifestations and their clinical management. Being an underdiagnosed pathology, knowledge about its clinical manifestations is essential in order to allow an early diagnosis and treatment, to ensure a better prognosis for the patient.
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Affiliation(s)
- Cristiana Sousa Pinto
- Medicina Geral e Familiar, Unidade de Saúde Familiar São Martinho, Penafiel, Portugal
| | - José Carlos Vidoedo
- Unidade de Angiologia e Cirurgia Vascular, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - João Almeida Pinto
- Unidade de Angiologia e Cirurgia Vascular, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - João Vasconcelos
- Unidade de Angiologia e Cirurgia Vascular, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Miguel Maia
- Unidade de Angiologia e Cirurgia Vascular, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - André Cruz
- Unidade de Angiologia e Cirurgia Vascular, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Elsa Neves
- Medicina Geral e Familiar, Unidade de Saúde Familiar São Martinho, Penafiel, Portugal
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7
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Abstract
A 76-year-old man without any prior history of abnormal urinalysis findings or renal insufficiency demonstrated mild renal dysfunction after coronary bypass graft surgery (CABG). Two months after CABG, pain and blueness in the toes (blue toe syndrome) appeared and, the serum creatinine level (S-Cr) increased from 1.2 to 2.0 mg/dL. On admission (3 months later), the urinary protein level was 0.5 g/day, white blood cell count 8,300/μL with eosinophils (Eo) 10.5%, S-Cr 2.1 mg/dL, and low-density lipoprotein (LDL) 106 mg/dL. Acute renal failure and blue toe syndrome due to a cholesterol embolism (CE) were diagnosed. Alprostadil 40 μg/day orally for 2 weeks and alprostadil 40 μg/day intravenously were used for 5 weeks, and Eo were 250/μL, S-Cr 2.5 mg/dL; however, blue toe syndrome gradually developed. At 8 weeks after admission, limaprost alfadex 30 μg/day orally was used for 3 weeks. However, the Eo gradually rose to 1,520/μL, S-Cr to 3.0 mg/dL, and LDL to 135 mg/dL, and LDL apheresis was therefore performed 20 times for CE. The data just after LDL apheresis was performed 10 times were as follows: Eo 1,120/μL, S-Cr 4.0 mg/dL, and LDL 89 mg/dL, and blue toe syndrome had disappeared. At 10 months after the first LDL apheresis, the Eo were 630/μL, S-Cr 2.9 mg/dL, and LDL 109 mg/dL. As a result, LDL apheresis was found to be beneficial for the treatment of CE with acute renal failure and blue toe syndrome after CABG.
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Affiliation(s)
- Toru Sanai
- Division of Nephrology, Department of Internal Medicine and Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan.
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8
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Ohata C, Imamura T. Painful purple toes. Cutis 2016; 98:E8-E10. [PMID: 27814416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Chika Ohata
- Department of Dermatology, Kurume University School of Medicine, Japan
| | - Taichi Imamura
- Department of Dermatology, Kurume University School of Medicine, Japan
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9
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Kobayashi H, Abe M, Murata Y, Maruyama T, Furukawa T, Oikawa O, Okada K. Low-density lipoprotein apheresis for corticosteroid-resistant skin lesions caused by cholesterol crystal embolism: a case report and review of the literature. J Artif Organs 2015; 18:285-9. [PMID: 25821197 DOI: 10.1007/s10047-015-0830-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/08/2015] [Indexed: 11/25/2022]
Abstract
Cholesterol crystal embolism (CCE) is an arterio-arterial embolism originating from the breakdown of atherosclerotic plaques in the aortic wall. The embolism affects the skin and kidney particularly, as well as frequently affects the gastrointestinal tract and other organs. Although there are no clearly effective direct therapies for CCE, corticosteroid therapy and combination therapy with low-density lipoprotein apheresis (LDL-A) followed by corticosteroids were recently reported to be effective for renal manifestations in some cases. However, few cases offer suggestions for the treatment of skin lesions caused by CCE. We report here a case of a 58-year-old man diagnosed with CCE with skin manifestations and kidney dysfunction who achieved complete remission after LDL-A. LDL-A may be a useful treatment for CCE, particularly in cases with skin manifestations.
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Affiliation(s)
- Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-chou, Itabashi-ku, Tokyo, 173-8610, Japan
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10
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11
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Faccenna F, Alunno A, Felli MMG, Castiglione A, Izzo P, Gossetti B, Stagnitti F, Laurito A, Izzo L, Gattuso R. Tibioperoneal true aneurysm: case report and literature review. G Chir 2011; 32:379-383. [PMID: 22018262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The true aneurysms of the infrapopliteal arteries are an unusual pathology with low incidence in the general population. They appear in the literature only as isolated case reports. True aneurysms of the infrapopliteal arteries represent a surgical problem, especially when a bifurcation is involved and when the distal vessels are affected by occlusive disease. CASE REPORT A 67 year old man with an aneurysm which involved the tibioperoneal trunk and the origin of peroneal and posterior tibial arteries was surgical treated. At three months follow up, a duplex ultrasonography (DUS) control showed the bypass patency and the total exclusion of the aneurismal sac. DISCUSSION Although the aneurysms of the infrapopliteal arteries are very uncommon and often asymptomatic, their associated vascular lesions and/or ischemic complications can lead to high risk of limb loss. When the aneurysm is large and/or symptomatic, the surgical treatment becomes mandatory. A conservative treatment and DUS follow up could be reserved to elderly patients and when the aneurysm is small and asymptomatic.
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Affiliation(s)
- F Faccenna
- Vascular Surgery Department, Sapienza, University of Rome, Italy
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12
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Iba Ba J, Mipinda JB, Makanga R, Bignoumba Ibouili R, Coniquet S, Moussavou Kombila JB, Boguikouma JB. [Purple extremities in black-skinned patients: blue toe syndrome as presenting sign of antiphospholipid antibody syndrome]. Med Trop (Mars) 2010; 70:283-284. [PMID: 20734601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although acral ischemia can involve several underlying mechanisms, suspicion of lupus warrants testing for antiphospholipid antibodies in patients with blue toe syndrome.
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Affiliation(s)
- J Iba Ba
- Service de Médecine A, Centre Hospitalier, Libreville, Gabon.
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13
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Puksić S, Haris V, Ljubanović D, Durasević Z, Galesić K. [Cholesterol crystal embolism and renal insufficiency: case report and literature review]. Lijec Vjesn 2009; 131:254-259. [PMID: 20030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Cholesterol crystal embolism with renal impairment is increasingly recognised as an iatrogenic complication of invasive vascular procedures. We present a 58-year-old patient in whom the presence of a classic triad of precipitating event (coronary angiography), subacute presentation of renal failure and cutaneous lesions (livedo reticularis and Blue Toe syndrome) suggested this entity. The confirmatory diagnosis was made by means of renal biopsy which revealed cholesterol crystals lodged in arteries. In our patient severe renal insufficiency requiering hemodialysis ensued. Glucocorticoid and statin therapy failed to recover the renal function. The patient died from acute myocardial infarction. Invasive cardiac procedures are increasing in number especially in the elderly population so higher incidence of cholesterol crystal embolism coud be expected in the future. Increased awareness of this syndrome is necessary for early recognition, which is crucial for treatment, and defining the high-risk patient in whom other modalities of coronary diagnostics coud be considered.
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Affiliation(s)
- Silva Puksić
- Klinika za unutarnje bolesti, Klinicka bolnica Dubrava, Zagreb
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14
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Liu DG, Liu FJ. [Cholesterol crystal embolism of toe: report of a case]. Zhonghua Bing Li Xue Za Zhi 2007; 36:857-858. [PMID: 18346364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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15
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Nijhof IS, Majoie IML, Dijkhorst-Oei LT, Bousema MT. [Blue toe syndrome; a sign of end-arterial occlusion]. Ned Tijdschr Geneeskd 2007; 151:1261-7. [PMID: 17624153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Three patients, two women aged 66 and 43 years, respectively, and a man aged 76 years, presented with sudden, painful, blue areas in the toes with intact peripheral pulsations. One patient had a myeloproliferative syndrome due to essential thrombocytosis, the second patient had thromboangiitis obliterans, and the third patient had a cholesterol embolism, possibly due to the use of oral anticoagulants. After treatment, one patient recovered fully and the other two improved significantly. The blue toe syndrome is the pathophysiological consequence of end-arterial occlusion and frequently the first manifestation of a systemic disorder, such as atheroembolism or vasculitis. Adequate treatment is possible in most cases. Therefore, it is very important to recognise this disorder and its possible causes so as to prevent further episodes of local symptoms and especially systemic complications.
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Affiliation(s)
- I S Nijhof
- Meander Medisch Centrum, Postbus 1502, 3800 BM Amersfoort
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16
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Pfurtscheller K, Kerbl R, Hanzer M, Muntean W. [Pernio as cause of a blue toe syndrome]. Klin Padiatr 2006; 219:240-2. [PMID: 16878289 DOI: 10.1055/s-2006-933456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The evaluation of a blue toe syndrome in children is a diagnostic challenge. The differential diagnosis includes pernio (chilblains) if all diagnostic tests are negative and a corresponding anamnesis is presented. In this report we illustrate the case of a 7 1/2- year-old girl who presented with two blue toes and discuss differential-diagnostic considerations.
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Affiliation(s)
- K Pfurtscheller
- Univ.-Klinik für Kinder- und Jugendheilkunde, Klinische Abteilung für Allgemeinpädiatrie, Graz, Osterreich.
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17
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Piccoli GB, Maddalena E, Fenoglio R, Bilucaglia D, Mezza E, Colla L, Rabbia C, Segoloni GP. The long-term dialysis patient with purple-blue toes. Nephrol Dial Transplant 2006; 21:2022-3. [PMID: 16627616 DOI: 10.1093/ndt/gfl136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Rollino C, Tomasini C, Di Placido R, Aprà F, Beltrame G, Ferro M, Quattrocchio G, Massara C, Quarello F. Cholesterol embolism after colonoscopy: a case report. Gastrointest Endosc 2006; 63:730-2. [PMID: 16564892 DOI: 10.1016/j.gie.2005.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2005] [Accepted: 11/07/2005] [Indexed: 02/08/2023]
Affiliation(s)
- Cristiana Rollino
- Department of Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza Donatore di sangue 3, 10154 Turin, Italy
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19
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Kügler CFA, Poser M, Mosel F, Ruehm S, Rudofsky G. Spontaneous dissection of the popliteal artery in a young man. A rare cause of the blue toe syndrome. INT ANGIOL 2006; 25:93-7. [PMID: 16520732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
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.
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Affiliation(s)
- C F A Kügler
- Department and Clinic of Angiology, University of Essen, Essen, Germany.
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20
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Minatohara K. Renal Failure Associated with Blue Toe Syndrome: Effective Treatment with Intravenous Prostaglandin E-1. Acta Derm Venereol 2006; 86:364-5. [PMID: 16874430 DOI: 10.2340/00015555-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Ignat'ev IM. [The 21st world congress of the International Association of Angiologists: review of the materials]. Angiol Sosud Khir 2005; 11:36-41. [PMID: 16041886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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22
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Iwakura T, Enomoto S, Yamamoto K, Sakamoto T, Okamura H. [Cholesterol crystal embolization exacerbated after the off-pump coronary artery bypass; report of a case]. Kyobu Geka 2004; 57:477-80. [PMID: 15202268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 66-year-old man with left main trunk disease was treated under a diagnosis of acute myocardial infarction based on coronary angiography by off-pump coronary artery bypass (OPCAB). About 1 month after operation, his renal function deteriorated and purpura appeared on both feet, especially at the toe tips. In this case, steroid therapy was performed and the patient survived. Cholesterol embolism rarely occurs after angiographic procedure or cardiovascular surgery. In general, it is associated with high morbidity and mortality, but no optimal treatment has yet been developed. This underlines the importance of careful observation and skin biopsy for early diagnosis.
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Affiliation(s)
- T Iwakura
- Department of Cardiovascular Surgery, Okamura Memorial Hospital, Shizuoka, Japan
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23
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Funabiki K, Masuoka H, Shimizu H, Emi Y, Mori T, Ito M, Nakano T. Cholesterol crystal embolization (CCE) after cardiac catheterization: a case report and a review of 36 cases in the Japanese literature. ACTA ACUST UNITED AC 2003; 44:767-74. [PMID: 14587658 DOI: 10.1536/jhj.44.767] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cholesterol crystal embolization (CCE) is a complication of atherosclerosis. A 67-year-old Japanese man underwent coronary artery bypass grafting. After the surgery, he underwent coronary angiography via the right femoral artery. Twelve days later, he suddenly developed acalculous cholecystitis and was treated with antibiotics. Gradual deterioration in renal function, purplish discoloration of the distal portion of his toes, and eosinophilia were noted. We performed a skin biopsy and made a diagnosis of CCE. Cilostazol and intravenous heparin improved the symptoms and decreased the creatinine level. We retrospectively studied the clinical features of 36 cases registered with a diagnosis of CCE in the Japanese literature.
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Affiliation(s)
- Kaoru Funabiki
- Division of Internal Medicine, Ise General Hospital, Ise, Japan
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24
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Jy W, Gagliano-DeCesare T, Kett DH, Horstman LL, Jimenez JJ, Ruiz-Dayao Z, Santos ES, Ahn YS. Life-threatening bleeding from refractory acquired FVIII inhibitor successfully treated with rituximab. Acta Haematol 2003; 109:206-8. [PMID: 12853696 DOI: 10.1159/000070973] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 03/12/2003] [Indexed: 11/19/2022]
Affiliation(s)
- Wenche Jy
- Wallace H. Coulter Platelet Laboratory, Division of Hematology/Oncology, University of Miami School of Medicine, Miami, FL 33136, USA
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25
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Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol 2003; 42:211-6. [PMID: 12875753 DOI: 10.1016/s0735-1097(03)00579-5] [Citation(s) in RCA: 192] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cholesterol embolization syndrome is a systemic disease caused by distal showering of cholesterol crystals after angiography, major vessel surgery, or thrombolysis. METHODS We prospectively evaluated a total of 1,786 consecutive patients 40 years of age and older, who underwent left-heart catheterization at 11 participating hospitals. The diagnosis of CES was made when patients had peripheral cutaneous involvement (livedo reticularis, blue toe syndrome, and digital gangrene) or renal dysfunction. RESULTS Twenty-five patients (1.4%) were diagnosed as having CES. Twelve patients (48%) had cutaneous signs, and 16 patients (64%) had renal insufficiency. Eosinophil counts were significantly higher in CES patients than in non-CES patients before and after cardiac catheterization. The in-hospital mortality rate was 16.0% (4 patients), which was significantly higher than that without CES (0.5%, p < 0.01). All four patients with CES who died after cardiac catheterization had progressive renal dysfunction. The incidence of CES increased in patients with atherosclerotic disease, hypertension, a history of smoking, and the elevation of baseline plasma C-reactive protein (CRP) by univariate analysis. The femoral approach did not increase the incidence, suggesting a possibility that the ascending aorta may be a potential embolic source. As an independent predictor of CES, multivariate regression analysis identified only the elevation of pre-procedural CRP levels (odds ratio 4.6, P = 0.01). CONCLUSIONS Cholesterol embolization syndrome is a relatively rare but serious complication after cardiac catheterization. Elevated plasma levels of pre-procedural CRP are associated with subsequent CES in patients who undergo vascular procedures.
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Affiliation(s)
- Yoshihiro Fukumoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Affiliation(s)
- S Spronk
- Vascular Laboratory, Ikazia Hospital, Rotterdam, The Netherlands
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Kudo T, Inoue Y, Sugano N, Iwai T. Atheroembolic signals detected by Doppler ultrasound scan monitoring in a patient with blue toe syndrome: report of a case. Surg Today 2003; 32:938-41. [PMID: 12376800 DOI: 10.1007/s005950200187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Toshifumi Kudo
- Department of Surgery, Division of Vascular Surgery, Tokyo Medical and Dental University School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Bhalla A, Gupta S, Jain AP, Jajoo UN, Gupta OP, Kalantri SP. Blue toe syndrome: a rare complication of acute pancreatitis. JOP 2003; 4:17-9. [PMID: 12555011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
CONTEXT Blue toe syndrome is an unusual complication of acute pancreatitis. It is characterized by tissue ischemia secondary to cholesterol crystal or atherothrombotic embolization leading to the occlusion of small vessels. Clinical presentation can range from a cyanotic toe to a diffuse multiorgan systemic disease that can mimic other systemic illnesses. CASE REPORT Here we describe a young male who developed this complication after acute alcoholic pancreatitis.
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Affiliation(s)
- Ashish Bhalla
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India.
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Ghilardi G, Massaro F, Gobatti D, Kunkl E, Scorza R. Temporary spinal cord stimulation for peripheral cholesterol embolism. J Cardiovasc Surg (Torino) 2002; 43:255-8. [PMID: 11887066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Cholesterol embolism is often an unrecognized complication of some cardiac and vascular procedures (i.e. coronarography, angioplasty, aortocoronary bypass, abdominal aortic aneurysmectomy) and of therapies affecting coagulation (thrombolysis, anticoagulation). The degree of pain associated with ischaemic and necrotic lesions secondary to cholesterol embolism involving the lower limbs is disproportionate to the extension of tissue involvement. Spinal cord stimulation (SCS) has been recognized as effective in relief of pain of ischaemic and neuropathic nature, although its mechanism of action is still not completely clear. The authors are unaware of previous reports of peripheral cholesterol embolism treated by SCS. Two case reports of inferior limb ischaemia secondary to cholesterol embolism in patients who had undergone cardiac invasive procedures. Temporary surgical implantation of SCS devices, which were removed after 4 to 6 weeks. Pain relief was achieved within 1 to 4 hours of surgical procedure. Any analgesic medications could be immediately discontinued. Pain control was effective and normal daily activities were rapidly regained. Ischaemic lesions healed within 4 to 6 weeks of SCS. Pain control is the most critical aspect of the management of peripheral cholesterol embolism without visceral organ involvement. SCS provided effective pain relief in the reported cases and its established ability to improve peripheral microcirculation allowed rapid resolution of necrotic lesions. Temporary SCS should be considered in the management of painful necrotic skin lesions secondary to iatrogenic cholesterol embolism.
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Affiliation(s)
- G Ghilardi
- Department of General Surgery, Insitute of Medicine, Surgery and Dentistry, S. Paolo Hospital, University of Milan, Milan, Italy.
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31
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Stabellini N, Cerretani D, Russo G, Rizzioli E, Gilli P. [Renal atheroembolic disease: evaluation of the efficacy of corticosteroid therapy]. G Ital Nefrol 2002; 19:18-21. [PMID: 12165941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Even though many organs may be involved and clinical manifestations are extremely variable, a sudden worsening of renal function after vascular surgery or invasive angiographic manoeuvres is a clue for the diagnosis of renal cholesterol crystal embolization. In rare cases the disease may also occur spontaneously during anticoagulant or thrombolytic therapy. Renal atheroembolism is becoming increasingly recognized as an important cause of renal failure particularly in elderly men, and is often associated with a bad outcome. To date there is no specific and proven useful treatment apart from a few anecdotal reports on the benefits of corticosteroids. PATIENTS AND METHODS We report a group of seven patients with cholesterol atheroembolic disease presenting acute renal failure; in six patients the disease appeared after coronary arteriography and PTCA performed in the last four months, and in one patient in an apparently spontaneous form. All the patients presented cutaneous lesions, livedo reticularis, purpuric rush, necrosis of the toes; laboratory data showed an increase of acute phase proteins and eosinophilia. Results. Treatment with prednisolone was begun at a dose of 40 mg/day i.v. for four days; the dose was reduced to prednisone 0.4-0.5 mg/kg/day for 1 week, than gradually reduced further and stopped within a month. Following therapy renal function rapidly improved; clinical symptoms of malaise and abdominal discomfort subsided, with amelioration of skin lesions and cyanosis of toes. CONCLUSIONS Despite the small number of patients studied, our experience suggests that corticosteroid treatment is an effective therapeutic option in cholesterol renal atheroembolic disease, especially in the more severe cases of acute renal failure.
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Affiliation(s)
- N Stabellini
- Divisione di Nefrologia, Arcispedale S. Anna, Ferrara, Italy.
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Nakamoto S, Kaneda T, Inoue T, Matumoto T, Onoe M, Kitayama H, Oka H, Zhang Z, Otaki M, Oku H. Disseminated cholesterol embolism after coronary artery bypass grafting. J Card Surg 2001; 16:410-3. [PMID: 11885774 DOI: 10.1111/j.1540-8191.2001.tb00543.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Blue toe syndrome caused by cholesterol emboli is a relatively benign disease. However, disseminated cholesterol embolism is a life-threatening condition. We describe here the case of a 71-year-old female admitted because of anterior chest pain and intermittent claudication. Following cardiac catheterization, warfarin potassium was administered. However, the patient's toes soon darkened bilaterally, and BUN and creatinine levels increased from the normal value. Skin discoloration and renal failure were improved after stopping warfarin potassium administration. The patient underwent coronary artery bypass grafting and left femoropopliteal bypass. Cerebral infarction and renal failure occurred postoperatively due to disseminated cholesterol embolism. The patient died from renal failure on the 16th postoperative day without regaining consciousness following surgery. For high risk patients, interventional procedures to the ascending aorta must be avoided. When CABG cannot be avoided for coronary revascularization, off-pump bypass and use of arterial grafts are recommended.
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Affiliation(s)
- S Nakamoto
- Department of Cardiovascular Surgery, Kinki University School of Medicine, Osakasayama, Osaka, Japan
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33
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Fukushima Y, Yoshioka M, Niina K, Onitsuka T. [Blue toe syndrome after coronary artery bypass grafting]. Kyobu Geka 2001; 54:489-92. [PMID: 11424500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We report three cases of blue toe syndrome (BTS) after coronary artery bypass grafting (CABG). All patients were cyanotic and exhibited painful toes two to four weeks after CABG. They were treated with antiplatelet and anticoagulant agents, and one patient underwent replacement of the abdominal aorta. Thus, BTS may occur after CABG with coronary angiography, extra-corporeal circulation or intraaortic balloon pumping. For the treatment of BTS, surgery remains the most effective option.
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Affiliation(s)
- Y Fukushima
- Department of Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan
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Guiserix J. [An innocent speed selector]. Presse Med 2000; 29:2226. [PMID: 11196059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Kazancioğlu R, Erkoç R, Bozfakioğlu S, Türk S, Gören T, Kayacan SM, Kiliçaslan I, Baykal C, Büyükbabani N, Aysuna N, Ark E. Clinical outcomes of renal cholesterol crystal embolization. J Nephrol 1999; 12:266-9. [PMID: 10493571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Cholesterol crystal embolization is an increasingly recognized disease, presenting with a wide clinical spectrum, usually occurring in elderly men who undergo an angiographic procedure or vascular surgery. We report three patients who developed systemic cholesterol embolic disease and varying degrees of renal failure after angiographic interventions of the coronaries.
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Affiliation(s)
- R Kazancioğlu
- Istanbul Faculty of Medicine, Department of Internal Medicine, Turkey.
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LaBerge JM, Kerlan RK. Special exhibit for the SCVIR Annual Meeting Film Panel Session: diagnosis and discussion of cases 5-8. Society of Cardiovascular & Interventional Radiology. Case 6. Blue-toe syndrome secondary to embolization from a complex right common iliac artery plaque containing fresh thrombus material. J Vasc Interv Radiol 1999; 10:653, 658-61. [PMID: 10498409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Affiliation(s)
- J M LaBerge
- Department of Radiology, University of California, San Francisco, CA 94143-0628
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Greenberg A. Case 24-1998: cholesterol atheroembolism. N Engl J Med 1998; 339:1857-8. [PMID: 9867568 DOI: 10.1056/nejm199812173392515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Affiliation(s)
- C A Lobo
- Department of Diagnostic Imaging, University of Ottawa, Ottawa Civic Hospital, ON, Canada
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-1998. A 76-year-old woman with cardiac and renal failure and gastrointestinal bleeding. N Engl J Med 1998; 339:329-37. [PMID: 9696641 DOI: 10.1056/NEJM199807303390508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Osterwalder P, Goehde SC, Stürmer J, Vetter W. [Livedo reticularis, acral necroses and renal failure. Cholesterol crystal embolisms]. Praxis (Bern 1994) 1998; 87:483-490. [PMID: 9587225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In a 67 year old patient with multiple cardiovascular risk factors a livedo reticularis, ischemic acral lesions as well as deterioration of renal function five weeks after cardiac catheterism and aorto-coronary bypass surgery led to suspicion of cholesterol embolism. Fundoscopy revealed cholesterol crystals in retinal vascular branches thus delivering important diagnostic information. Atheromatous lesions of the entire aorta and the ilio-femoral arteries were possible sources for embolism. The outcome was favorable. The lesions of the toes regressed and renal failure did not progress to dialysis. The diagnostic steps taken, the clinical picture of cholesterol embolism, the use of imaging and therapeutic options are discussed.
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Affiliation(s)
- P Osterwalder
- Department für Innere Medizin, Medizinische Poliklinik, Universitätsspital Zürich
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Affiliation(s)
- S Zaman
- Poole Hospital NHS Trust, Dorset, UK
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43
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Tuininga YS, Gökemeijer JD. [Blue toes and kidney insufficiency]. Ned Tijdschr Geneeskd 1997; 141:1025-8. [PMID: 9340557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Three patients, two women aged 73 and 70 and one man aged 58 years, were known with hypertension and (or) coronary disease. They developed renal insufficiency and purple toes due to cholesterol crystal embolisation. In two of the three patients invasive procedures (femoropopliteal bypass surgery and replacement of the aortic valve, respectively) had provoked the embolisation process. Growing awareness of symptoms such as purple toes is important as the increasing use of intravascular procedures will lead to higher incidence of this syndrome with renal insufficiency as the most severe clinical complication.
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Affiliation(s)
- Y S Tuininga
- Martini Ziekenhuis, locatie Van Swieten, afd. Interne Geneeskunde, Groningen
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Abstract
The role of anticoagulation in the blue toe syndrome is unresolved. We describe the sonographic appearance of atherosclerotic plaques in the thoracic aorta imaged by transesophageal echocardiography in 2 patients with blue toe syndrome who had reembolization while taking therapeutic levels of anticoagulants. The findings of complex atheromas associated with mobile highly echodense linear structures by transesophageal echocardiography may be predictive of reembolization in patients with blue toe syndrome who are taking anticoagulants.
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Affiliation(s)
- H J Willens
- Department of Medicine, University of Miami, School of Medicine, FL, USA
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Abstract
Among 1011 patients undergoing infrarenal aortic and infrainguinal vascular surgery in a 90-month period (1986-1993), 29 patients (2.9%) with clinical, angiographic and pathologic evidence of atheroembolism were identified. Over one-third (44.8%) of atheroemboli were iatrogenic and the rest spontaneous. All iatrogenic atheroemboli were precipitated by angiographic (n = 11; 84.6%) or operative manipulation (n = 2; 15.4%). The sources of emboli were in the abdominal arota (16), iliac (seven) and femoropopliteal (six) arteries. 'Trash foot' occurred in 19 patients (seven bilateral) and occlusions of tibioperoneal/digital arteries were seen in seven, renal and dermal microcirculation in two each, and calf muscles in one. Larger conduits were affected in three instances (common femoral, popliteal and in situ saphenous vein graft). The management consisted of 54 (43 surgical and 11 endovascular) procedures concurrently with thrombolytic, anticoagulant and antiplatelet therapy. Three early (10.3%) and two late (6.9%) deaths (overall mortality rate 17.2%), eight major (27.6%) and five minor (17.2%) amputations, and four (13.8%) instances of renal failure occurred in 17 patients resulting in a 58.6% complication rate. Besides initial angiography, 53 invasive procedures were required in 25 patients. Among these, 12 patients could be managed with a single definitive procedure in contrast to a group of 13 patients that required 41 (average 3.2 per patient) procedures. The incidence of foot ischemia, reoperation and amputation was higher in the spontaneous group, whereas, the iatrogenic group incurred a higher incidence of endovascular interventions, greater mortality and new onset renal failure. The high morbidity and mortality of atheroemboli demand prompt recognition and treatment, as well as attempts at prevention to achieve good results.
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Affiliation(s)
- P V Sharma
- Department of Surgery, Lincoln Medical and Mental Health Center, Bronx, New York, USA
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Abstract
Cyanosis of the digits may have several etiologies ranging from trauma to connective tissue disease; however, the most common cause of the so-called blue toe syndrome is atheroembolic disease or aneurysm and is frequently misdiagnosed on initial presentation. Pedal pulses are often palpable which may misdirect the physician from a diagnosis of vascular pathology. Furthermore, the proximal source of embolic shower may be far from the sight of symptoms. Noninvasive vascular testing, peripheral angiography, abdominal and popliteal ultrasonography, and echocardiography are all techniques that may be beneficial in discovering the origin of emboli. Atheroembolisms and aneurysms can be limb-threatening or life-threatening and hence early diagnosis is imperative.
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Affiliation(s)
- B D Caldwell
- Department of Podiatric Medicine, Ohio College of Podiatric Medicine, Cleveland, USA
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Abstract
BACKGROUND Surgical procedures performed exclusively for atheroembolic events arising from the thoracic aorta rarely have been reported. Presented here are 2 patients who underwent successful operation for these problems. METHODS The clinical presentation, diagnostic evaluation and surgical approach to 2 patients with different embolic sources in the thoracic aorta are presented. One patient had experienced three strokes and was noted by multiplane transesophageal echocardiography to have protruding atheromas with ulcerations in the transverse arch and origin of the brachiocephalic vessels. The transverse arch was replaced using hypothermic circulatory arrest with individual reimplantation of the brachiocephalic vessels. The second patient presented with "blue toe" syndrome from mobile atheromas in the mid-descending thoracic aorta defined by transesophageal echocardiography. A localized debridement was performed using simple aortic cross-clamping. RESULTS Both patients had uneventful postoperative courses and had no further atheroembolic events. CONCLUSIONS When standard diagnostic modalities do not delineate an embolic source for either stroke or peripheral embolization, transesophageal echocardiography is recommended as an excellent means of identifying atheromas in the thoracic aorta that could be the source for emboli. Once these lesions are identified, a surgical procedure should be performed to prevent further embolization.
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Affiliation(s)
- R M Bojar
- Division of Cardiothoracic Surgery, New England Medical Center, Boston, MA 02111, USA
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Ena J, Gutiérrez F, Gómez A, Vilar A. [Digital ischemia, renal failure and livedo reticularis after fibrinolysis. Cholesterol embolism]. Rev Clin Esp 1996; 196:187-8. [PMID: 8650391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J Ena
- Servicio de Medicina Interna Hospital SVS de la Marina Baixa, Villajoyosa, Alicante
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Blackshear JL, Oldenburg WA, Cohen MD. Making the diagnosis when the patient has 'blue toes'. Geriatrics (Basel) 1994; 49:37-9, 43-5. [PMID: 7982584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Painful "blue toes" describes a physical sign whose meaning may be discovered through a carefully taken history, physical, and laboratory evaluation. Accurate diagnosis is important, because therapy for one specific condition may be contraindicated for another. When embolism is suspected, ultrasound examination of the heart, aorta, and periphery may be useful prior to angiography in order to avoid exacerbation of cholesterol crystal embolization. Transesophageal echocardiography or MRI may be needed to exclude a thoracic aortic source. The differential diagnosis can be divided into three categories: emboli from the cardiac and arterial system, acquired hypercoagulability disorders, and syndromes that lead to peripheral vascular pathology. A clinical approach to the evaluation of patients is presented, with case reports.
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Affiliation(s)
- J L Blackshear
- Section of Cardiovascular Diseases, Mayo Clinic Jacksonville, FL
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