Blue Toe Syndrome as a Rare Complication of Abdominal Aortic Aneurysm: Case Report

Abdominal aortic aneurysm (AAA) is a vascular disease that often remains asymptomatic until rupture or the occurrence of complications. The mortality rate of rupture exceeds 80%. Most AAAs are discovered incidentally; rare presentations may occur due to peripheral embolization from intra-aneurysmal thrombi. One of the manifestations is blue toe syndrome. It is painful cyanotic toes with preserved peripheral pulses. We report the case of a 67-year-old man with a history of ischemic heart disease, smoking, and opium addiction who presented with bilateral toe pain, numbness, and cyanosis without abdominal symptoms or claudication. peripheral pulses were present in the physical examination. The laboratory tests excluded vasculitis and hypercoagulable states. CT angiography demonstrated a large (75 mm) infrarenal AAA with mural thrombosis, specifying the source of emboli. The patient underwent successful endovascular aortic aneurysm repair (EVAR) with adjunctive coil embolization of the inferior mesenteric artery. Postoperatively, limb perfusion was restored, symptoms resolved, and the patient was discharged on dual antiplatelet and statin therapy. At 12-month follow-up, he was symptom-free with no evidence of ischemia or endoleak. This case explains an uncommon presentation of AAA as blue toe syndrome. Diagnosis of peripheral embolic events as a symptom of AAA is necessary for timely imaging and treatment. Timely diagnosis and intervention prevent ischemic complications and decrease the risk of aneurysm rupture. EVAR is a safe and effective intervention, especially in cases with significant comorbidities.