Digital ischaemia and palpable pedal pulses

Digital ischaemia in the presence of an otherwise well-perfused foot in the non-diabetic patient presents diagnostic problems especially as the manifestations are frequently evanescent. Eighty such patients (sixty men and twenty women aged 55-84 years) who presented to St. Laurence's Hospital from 1982 to 1985 inclusive were evaluated. Micro-embolization was inferred from the demonstration of a cardiac (20) or an arterial source (42) in 62 of 80 patients. In 14 of the remaining 18 patients a malignancy was diagnosed, which was found to be visceral cancer in 11 cases. Indium platelet scanning revealed platelet aggregation in 14 of 26 patients examined. Laboratory evidence of abnormalities of platelet aggregation or blood coagulation was found in only 6 patients. There have been no further symptoms in 37 patients who have been treated surgically or in 17 of 21 patients who have been treated with either anticoagulation or antiplatelet therapy.