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Blue toe syndrome: treatment with percutaneous atherectomy

B L Dolmatch1, K S Rholl, L B Moskowitz

  • 1Miami Vascular Institute, Baptist Hospital, FL 33176.

Radiology
|December 1, 1989
PubMed

Insights

Percutaneous atherectomy effectively treats blue toe syndrome by removing emboli from superficial femoral artery lesions. This minimally invasive procedure resolves digital ischemia without surgery, offering histologic insights into embolic sources.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Dermatology

Background:

  • Blue toe syndrome (BTS) is characterized by digital ischemia despite palpable pedal pulses.
  • It results from microembolization to distal vessels from a proximal arterial source.
  • Superficial femoral artery (SFA) lesions are a common cause of embologenic BTS.

Purpose of the Study:

  • To evaluate the efficacy of percutaneous transluminal atherectomy (PTA) in treating embologenic SFA lesions in patients with BTS.
  • To assess the safety and outcomes of PTA in this patient population.
  • To investigate the histological composition of embolic material from SFA lesions.

Main Methods:

  • Seven patients with BTS underwent PTA for SFA stenosis.
  • Atherectomy devices were used to remove embologenic material.
  • Clinical outcomes, including resolution of ischemia and need for surgery, were monitored.
  • Histological analysis of atherectomy specimens was performed.

Main Results:

  • All seven patients experienced prompt healing of ischemic toes post-PTA.
  • No patient required surgical revascularization or amputation.
  • One patient had recurrent stenosis treated successfully with a larger atherectomy device.
  • Histology revealed fibrin-platelet aggregates and thrombus as primary embolic sources, with some cholesterol atheroma.

Conclusions:

  • Percutaneous atherectomy is an effective and safe treatment for embologenic SFA stenoses causing blue toe syndrome.
  • PTA offers nonsurgical removal of embolic material and provides diagnostic histological information.
  • This approach avoids surgical intervention and amputation in selected BTS patients.

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