Complex Aortic Plaques and Polycythemia Vera Presenting as Blue Toe Syndrome Without Peripheral Arterial Disease

Atherosclerosis can cause cardiovascular complications, but the risk is further exacerbated by comorbid prothrombotic conditions.

We describe a case of a 58-year-old man who presented with distal digit pain and was found to have complex aortic atherosclerosis and polycythemia vera that resulted in recurrent distal thromboembolism in the absence of peripheral artery disease. He had a prolonged course that required serial imaging studies and laboratory tests to elucidate the diagnosis.

This case highlights the importance of addressing prothrombotic conditions in patients with complex aortic plaque. Clinical stability was achieved only through the combination of lifestyle modifications, anticoagulation, antiplatelet therapy, and appropriate treatment of polycythemia vera.

Current guidelines do not adequately address the complexities involved in managing patients with atherosclerotic disease and hematologic prothrombotic comorbidities. Research on antiplatelet therapy and direct oral anticoagulation for treating distal embolization from unstable aortic plaques is needed.