Department of Internal Medicine and Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea.
Department of Pathology, Hallym University College of Medicine, Seoul, Korea.
Kidney Res Clin Pract. 2013 Dec;32(4):186-9. doi: 10.1016/j.krcp.2013.08.004. Epub 2013 Oct 10.
Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE), which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.
蓝趾综合征是胆固醇栓塞（CE）引起的组织缺血的最常见表现，如果严重，可导致受影响的下肢截肢。然而，目前缺乏任何有效的治疗方法。我们遇到了一例伴有多种动脉粥样硬化危险因素的患者，其自发性出现蓝趾综合征和急性肾衰竭。肾活检证实了 CE 的存在。尽管进行了包括前列腺素治疗和麻醉在内的药物治疗，但趾部病变进展为坏疽，伴有缺血性疼痛加剧。因此，我们进行了腰椎交感神经切除术，这不仅为缺血下肢提供了足够的血流，还缓解了疼痛，使坏疽病变得以愈合，避免了趾部截肢。这是首例报道的由 CE 引起的难治性缺血性趾综合征患者通过交感神经切除术成功治疗的病例。我们的观察结果表明，交感神经切除术可能对某些 CE 相关蓝趾综合征患者有益。
