Blue Toe Syndrome Responding to Direct Hemoadsorption Therapy with the Rheocarna^® Device

A man in his 80s who was on maintenance dialysis and warfarin therapy for atrial fibrillation developed sudden mottled cyanosis and multiple ulcers on his toes, without any apparent trigger. Despite no significant stenosis in the lower extremity arteries, he had a shaggy mural thrombus in the abdominal aorta, leading to a diagnosis of blue toe syndrome. Conservative treatment was ineffective, prompting the use of a novel apheresis device (Rheocarna^®; Kaneka, Osaka, Japan) for direct blood adsorption therapy. This intervention resulted in the healing of his toe ulcers. Blue toe syndrome is often refractory with no established treatment. The Rheocarna^® device shows promise as a potential therapeutic option.