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Dilemmas in dealing with the blue toe syndrome: aortic versus peripheral source
American Journal of Surgery
|December 1, 1984
Summary
Peripheral atherosclerotic lesions are the primary source of blue toe syndrome emboli. Exploring these distal lesions first in patients with aortoiliac disease leads to effective treatment with minimal complications.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Blue toe syndrome presents a diagnostic challenge in identifying the source of emboli.
- Distinguishing between central aortic and peripheral embolization is crucial for effective treatment.
Observation:
- Six patients with unilateral blue toe syndrome were evaluated.
- Two patients had moderate aortoiliac atherosclerosis with superficial femoral artery stenoses.
- Four patients had mild aortoiliac disease with localized plaques in the superficial femoral or popliteal arteries.
Findings:
- Peripheral lesions were explored first in all patients.
- Ulcerated plaques with adherent white thrombi were identified as the source of embolization.
- Localized thromboendarterectomy or reversed saphenous vein grafting were performed with no morbidity or mortality.
Implications:
- Distal atherosclerotic lesions should be prioritized as the source of embolization in blue toe syndrome.
- Direct exploration of peripheral lesions is essential, even with concomitant aortoiliac disease.
- This approach offers a curative solution with minimal patient risk.