Angioplasty with stenting is effective in treating blue toe syndrome

A. Renshaw, T. McCowen, E. A. Waltke, S. P. Wattenhofer, R. W. Tahara, Bernard Timothy Baxter

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Blue to syndrome is a manifestation of distal embolization associated with significant pain and risk of tissue loss. The recommended treatment options for this problem include endarterectomy or bypass with exclusion of the source of emboli. Although focal arterial stenosis can be effectively treated with angioplasty, it is unclear whether performing angioplasty in a lesion suspected of causing distal embolization might actually worsen the condition or what long-term effects this would have in preventing future embolization. The purpose of this study was to evaluate the treatment and outcome of a series of patients with unilateral blue toe syndrome treated with percutaneous angioplasty and stenting. During a 5-year period, a total of 8 patients were identified with unilateral blue toe syndrome. Ankle/brachial indices (ABIs) were obtained, followed by arteriography. The study group included 4 men and 4 women with an age range of 35 to 83 years. Their atherosclerotic risk factors included smoking (8), hypertension (5), diabetes mellitus (3), and hypercholesterolemia (1). One patient had a history of illicit drug use. The patients were followed up by repeat clinical examinations and vascular laboratory studies. Arteriography typically demonstrated a focal preocclusive lesion with thrombus at the distal end of the lesion. Angioplasty and stent placement was technically successful in all cases. The ABIs increased following angioplasty (before 0.81 ±0.05; after 1.02 ±.05). The symptoms resolved in all 8 patients over the ensuing month, and there were no recurrences with a mean follow-up of 18.5 months (range 4 to 36 months). There was 1 death at 4 months associated with preexisting colon carcinoma. Unilateral arterial to arterial emboli were found in association with focal preocclusive lesions. Despite the presence of thrombus in some of the lesions, these patients were not acutely worse following angioplasty. There was good initial angiographic success in all cases. There was also hemodynamic improvement as shown by the increased ankle/brachial indices. Although long-term follow-up is not available, these intermediate results suggest that angioplasty and stenting should be considered a reasonable alternative to standard operative approaches for patients with blue to syndrome associated with embolization from a focal stenosis.

Original languageEnglish (US)
Pages (from-to)155-159
Number of pages5
JournalVascular and Endovascular Surgery
Volume36
Issue number2
DOIs
StatePublished - Jan 1 2002

Fingerprint

Blue Toe Syndrome
Angioplasty
Ankle Brachial Index
Embolism
Angiography
Pathologic Constriction
Thrombosis
Nociceptive Pain
Endarterectomy
Street Drugs
Hypercholesterolemia
Stents
Blood Vessels
Diabetes Mellitus
Colon
Hemodynamics
Smoking
Hypertension
Carcinoma
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Angioplasty with stenting is effective in treating blue toe syndrome. / Renshaw, A.; McCowen, T.; Waltke, E. A.; Wattenhofer, S. P.; Tahara, R. W.; Baxter, Bernard Timothy.

In: Vascular and Endovascular Surgery, Vol. 36, No. 2, 01.01.2002, p. 155-159.

Research output: Contribution to journalArticle

Renshaw, A, McCowen, T, Waltke, EA, Wattenhofer, SP, Tahara, RW & Baxter, BT 2002, 'Angioplasty with stenting is effective in treating blue toe syndrome', Vascular and Endovascular Surgery, vol. 36, no. 2, pp. 155-159. https://doi.org/10.1177/153857440203600210
Renshaw, A. ; McCowen, T. ; Waltke, E. A. ; Wattenhofer, S. P. ; Tahara, R. W. ; Baxter, Bernard Timothy. / Angioplasty with stenting is effective in treating blue toe syndrome. In: Vascular and Endovascular Surgery. 2002 ; Vol. 36, No. 2. pp. 155-159.
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