[The blue toe syndrome and its pathogenic significance. A case report]

A 64-years-old woman complained of fixed cyanosis and rest pain of the 2nd, 3rd and 4th toes of the right foot, after a sudden onset one month previously to the clinical examination. The diagnosis of "blue toe syndrome" was then made. She was in a post-menopause state, with no hormonal substitution therapy, complaining also of obesity, arterial hypertension and hyperlipidemia, under medication but no laboratory control. Blood tests excluded an hypercoagulable state and the ECG revealed no significant abnormalities. Angio-CT scans and conventional angiography disclosed an atherosclerotic lesion at the femoropopliteal level, with an adherent and floating thrombus in the arterial lumen, causing microemboli to the collateral digital arteries. The complex lesion was removed through a local thromboendarterectomy, followed by a Carrel-DeBakey patch graft angioplasty, using autologous saphenous vein. Post operative course was uneventfull, with an immediate recovery of the clinical picture. Double antiplatelet therapy was advised and an extensive investigation of the possible relationship of this event with an occult malignancy was started, with no conclusive results, until now. The patient was placed in a clinical, laboratory and imagiologic surveillance program and the main features of this entity are emphasized and discussed, according to the data published in the literature on the subject.