Presentation
Characteristic microvascular, ischemic skin findings are present in most cases of CES. [cancertherapyadvisor.com]
Diagnosis is usually (definitely) confirmed with skin or muscle biopsy and fundoscopic examination presenting cholesterol crystals. [escardio.org]
Acute renal failure is present in 25–50% of atheroembolic cases [ 2 ]. [academic.oup.com]
Spontaneous embolization was once the most common presentation. With the increase in endovascular interventions, this ... [accesssurgery.mhmedical.com]
Case Presentation: A 71‐year‐old woman with hypertension presented from an outside hospital for a second opinion. [shmabstracts.com]
Entire Body System
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Lower Extremity Pain
Case report A 55-year-old man was admitted to the hospital with a four-month history of bilateral lower extremity pain and blue discoloration of toes. The bilateral foot pain had worsened for the past 1-2 months. [scielo.br]
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Vietnamese
Русский (Russian) ಕನ್ನಡ (Kannada) 한국어 (Korean) עברית (Hebrew) Український (Ukrainian) اردو (Urdu) Magyar (Hungarian) मानक हिन्दी (Hindi) Indonesia (Indonesian) Italiano (Italian) தமிழ் (Tamil) Türkçe (Turkish) తెలుగు (Telugu) ภาษาไทย (Thai) Tiếng Việt (Vietnamese [definitions.net]
Musculoskeletal
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Myalgia
Atheroembolic disease may present with general symptoms of fever, myalgias, headache, weight loss and diarrhea [ 1 ]. [academic.oup.com]
Myalgia and muscle tenderness - Cutaneous lesions (ulcers and necrosis) - Lacelike pattern of blue0red mottling with normal skin - Palpable purpura - Temperature changes - Cyanosis - Absent capillary fill time (CFT) What is intermittent claudication [brainscape.com]
Constitutional signs and symptoms such as fever, weight loss, anorexia, fatigue, and myalgias are frequent manifestation of the inflammatory response. [ahajournals.org]
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Decrease in Height
[…] peak height Partial loss of flow reversal Loss of arterial rebound Describe what a moderate obstruction looks like on a doppler ultrasound MONOPHASIC (one little hump) Rounding of upstroke/downstroke Decreased peak height Absend flow reversal Absent [brainscape.com]
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Muscle Tenderness
Myalgia and muscle tenderness - Cutaneous lesions (ulcers and necrosis) - Lacelike pattern of blue0red mottling with normal skin - Palpable purpura - Temperature changes - Cyanosis - Absent capillary fill time (CFT) What is intermittent claudication [brainscape.com]
Skin
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Petechiae
Blue to purple discoloration with petechiae on the right foot. (A) Scanning view (H&E, 40). (B) Ischemic necrosis of epidermis, and red blood cell extravasation (H&E, 200). [ncbi.nlm.nih.gov]
Figure 1: Diffuse livedo reticularis and cyanosis on the toes; skin ulceration on the second toe of the left foot Click here to view In BTS, physical examination can reveal livedo reticularis, gangrene, cyanosis, skin ulceration, purpura, and petechiae [e-ijd.org]
There may also be scattered areas of petechiae or cyanosis of the soles of the feet. [dermnetnz.org]
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Skin Ulcer
Figure 1: Diffuse livedo reticularis and cyanosis on the toes; skin ulceration on the second toe of the left foot Click here to view In BTS, physical examination can reveal livedo reticularis, gangrene, cyanosis, skin ulceration, purpura, and petechiae [e-ijd.org]
Urogenital
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Renal Injury
Renal injury, the only feature that is easily quantified, typically progresses subacutely and commonly comes to clinical attention only several weeks later. [cancertherapyadvisor.com]
Workup
Her urine sediment and vasculitis workup were otherwise unremarkable. There was debate over whether to obtain a biopsy (renal vs. skin) to confirm the diagnosis and whether to continue anticoagulation. [shmabstracts.com]
Echocardiography, a carotid Doppler study, a coagulation profile and a disseminated intravascular coagulation workup were all normal. The patient was started on aspirin, pentoxifylline and heparin. [pancreas.imedpub.com]
Although aortic arch atherosclerosis is common in patients with ischemic stroke, aortography (performed as an add-on to conventional cerebral angiography performed during diagnostic workup of ischemic strokes) frequently fails to identify plaque detected [ahajournals.org]
Treatment
The treatment consists in surgical or percutaneous elimination of the source of embolisation. Medical treatment is mostly symptomatic. [escardio.org]
Although the efficacy of treatment with PGE-1 in renal failure due to CCE has not been reported before, it was effective enough to prevent our patient from requiring haemodialysis. [medicaljournals.se]
If this happens, amputation may be necessary so early treatment is essential. Here we will look at the common symptoms, causes, diagnosis and treatment options for blue toe syndrome. [foot-pain-explored.com]
The overall benefit of the endovascular treatment of AAA is well established. 3-5 There was also the option to perform the renal angioplasty before the aneurysm treatment. [scielo.br]
After treatment, one patient recovered fully and the other two improved significantly. [ntvg.nl]
Prognosis
Prognosis is usually very good in mild forms of the condition where just the toes are affected. In more severe cases, the pain in the toes is disproportional to the degree of blue discolorations. [farinfraredhealth.com]
Mild forms of the disease have a good prognosis and subside without sequelae. However, diffuse multisystemic forms have a very poor prognosis. The kidney is the organ that is most often affected (in approximataly 50 % of cases). [escardio.org]
Gastrointestinal involvement portends a poorer overall prognosis, with 1-year mortality as high as 30-40%. Renal prognosis is highly variable. [cancertherapyadvisor.com]
and 3) a “diffuse multisystemic” form with a very poor prognosis [10]. [pancreas.imedpub.com]
Mild forms of blue toe syndrome have a good prognosis and subside without sequelae [1]. However, cholesterol fragments blocking blood vessels to other organs can lead to multi-organ disorder [1]. Involvement of the kidneys has a poor prognosis. [dermnetnz.org]
Etiology
Atheroembolism - Cardiac embolism - Hyperviscosity syndromes - Hypercoagulability states - Vasculitis - Miscellaneous What are the most common etiologies of blue toe syndrome - #1 atrial fibrillation (cardiac embolism) - Leukemias (hyperviscosity syndrome [brainscape.com]
ETIOLOGY AND PATHOPHYSIOLOGY The most important risk factor is established atherosclerosis. This is a process in which emboli from proximal lesions (plaque) produce ischemia in distal arterial beds. [accesssurgery.mhmedical.com]
Livedo reticularis, although a classic finding in CES, is a non-specific sign of cutaneous ischemia that may be seen in other disorders of the small arteries (vasculitides) and in shock of any etiology. [cancertherapyadvisor.com]
Martins G 24861307 2014 21 Blue toe syndrome treated with sympathectomy in a patient with acute renal failure caused by cholesterol embolization. 38 Kim MG...Kang SS 26877940 2013 22 [Foot lesions]. 38 Stelzner C...Unger L 24114468 2013 23 Toe Necrosis, Etiologies [malacards.org]
Cyanosis of the digits may have several etiologies ranging from trauma to connective tissue disease, however the most common cause of blue toe syndrome is atheroembolic disease or aneurysm. [escardio.org]
Epidemiology
Peak incidence : 60–80 years of age Sex : References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Pathophysiology
The blue toe syndrome is the pathophysiological consequence of end-arterial occlusion and frequently the first manifestation of a systemic disorder, such as atheroembolism or vasculitis. Adequate treatment is possible in most cases. [ntvg.nl]
ETIOLOGY AND PATHOPHYSIOLOGY The most important risk factor is established atherosclerosis. This is a process in which emboli from proximal lesions (plaque) produce ischemia in distal arterial beds. [accesssurgery.mhmedical.com]
Pathophysiologically chylomicrons and VLDL have been shown to develop calcium dependent agglutination by C-reactive proteins in acute pancreatitis, which could result in vascular occlusion and resultant infarction [9]. [pancreas.imedpub.com]
Discolouration may affect one foot or both, depending on the underlying pathophysiology. It is often painful and may be associated with claudication. [dermnetnz.org]
Because the pathophysiology does not involve thrombosis, antiplatelet and antithrombotic therapies have no direct role in therapy. Controversy surrounds the decision whether to continue established antithrombotic therapy in patients who develop CES. [cancertherapyadvisor.com]
Prevention
Embolism, Cholesterol Femoral Artery Iliac Artery Toes abstract In patients with severe coronary artery disease and blue toe syndrome, the combination of external iliac ligation and axillary-bifemoral bypass is an effective and durable procedure to prevent [vivo.med.cornell.edu]
Therefore, it is very important to recognise this disorder and its possible causes so as to prevent further episodes of local symptoms and especially systemic complications. Ned Tijdschr Geneeskd. 2007;151:1261-7 [ntvg.nl]
Treatment and Prevention Medical treatment is important and varies depending on the cause. Warfarin, an anticoagulant, is prescribed which clears the blood of clots, if the cause is an embolism. [feetfirstinc.com]
Although the efficacy of treatment with PGE-1 in renal failure due to CCE has not been reported before, it was effective enough to prevent our patient from requiring haemodialysis. [medicaljournals.se]
Treatment included prevention of further emboli including a high‐dose statin and avoiding further instrumentation. Discussion: Cholesterol embolization syndrome occurs in up to 1% of patients undergoing angiography. [shmabstracts.com]