Kumpe D A, Zwerdlinger S, Griffin D J
Department of Radiology, University of Colorado Health Sciences Center, Denver.
Radiology. 1988 Jan;166(1 Pt 1):37-44. doi: 10.1148/radiology.166.1.2962225.
Ten patients with classical blue digit syndrome were treated with percutaneous transluminal angioplasty (PTA). None experienced embolization. Nine were clinically improved; in eight, microembolization did not recur during follow-up of 7-86 months (mean, 28 months). Three clinical and three angiographic features were common to these eight patients: (a) few clinical episodes of microembolization; (b) no episodes of macroembolization; (c) no livedo reticularis in the affected extremity, and no symptoms of systemic cholesterol embolization; (d) focal, high-grade (greater than 90%) stenoses that were hemodynamically significant; (e) no diffuse atheromas in the aorta; (f) patent tibial runoff arteries. Affected patients with these clinical and angiographic characteristics make up a subgroup, previously unrecognized, to the authors' knowledge, in whom PTA followed by antiplatelet therapy should be the initial treatment of choice. The blue digit syndrome in these patients was probably due to microemboli composed of fibrinoplatelet aggregates rather than cholesterol debris.
10例典型蓝指综合征患者接受了经皮腔内血管成形术（PTA）治疗。无一例发生栓塞。9例临床症状改善；其中8例在7 - 86个月（平均28个月）的随访期间微栓塞未复发。这8例患者有3个临床特征和3个血管造影特征：（a）微栓塞的临床发作次数少；（b）无大栓塞发作；（c）受累肢体无网状青斑，无全身胆固醇栓塞症状；（d）局灶性、高度（大于90%）狭窄且具有血流动力学意义；（e）主动脉无弥漫性动脉粥样硬化；（f）胫动脉分支通畅。具有这些临床和血管造影特征的受累患者构成了一个作者所知此前未被认识的亚组，对于该亚组患者，PTA联合抗血小板治疗应作为首选的初始治疗方法。这些患者的蓝指综合征可能是由纤维蛋白血小板聚集体而非胆固醇碎片组成的微栓子所致。
