Bols A, Nevelsteen A, Verhaeghe R
Department of Bleeding and Vascular Disorders, University Hospital Gasthuisberg, Leuven, Belgium.
Int Angiol. 1994 Sep;13(3):271-4.
Five patients with a "blue or purple" toe syndrome due to atheromatous embolization probably precipitated by oral anticoagulant therapy are reported. In four, the symptoms started a few weeks after initiation of oral anticoagulants and in the fifth they were clearly aggravated by coumarinic drugs. Prior to anticoagulation, one patient had received a course of thrombolytic therapy and two had undergone an arterial catherization without embolic events. A diagnostic arteriography performed in four patients caused no new symptoms. All patients had advanced atherosclerosis. A shaggy aorta and/or pelvic arteries were found in four and in the fifth a highly stenotic femoral lesion appeared the source of peripheral embolization. Oral anticoagulants were interrupted in all five and four underwent reconstructive vascular surgery to eradicate the nidus of atheromatous emboli. One died postoperatively from multiple organ failure. The poor condition of the fifth patient precluded aorto-iliac surgery. No new episodes of embolization occurred and the symptoms disappeared, although one patient needed a toe amputation for a skin lesion that had proceeded to gangrene. The possible role of anticoagulant drugs in precipitating atheromatous embolization is discussed and the importance of recognizing the syndrome is emphasized.
报告了5例因动脉粥样硬化栓塞导致“蓝色或紫色”足趾综合征的患者，可能由口服抗凝治疗诱发。其中4例症状在开始口服抗凝剂几周后出现，第5例症状因香豆素类药物明显加重。抗凝治疗前，1例患者接受过溶栓治疗疗程，2例接受过动脉插管且未发生栓塞事件。4例患者进行的诊断性动脉造影未引发新症状。所有患者均有晚期动脉粥样硬化。4例发现主动脉和/或盆腔动脉表面粗糙，第5例发现高度狭窄的股动脉病变是周围栓塞的来源。所有5例患者均中断口服抗凝剂，4例接受了血管重建手术以根除动脉粥样硬化栓子的病灶。1例术后死于多器官功能衰竭。第5例患者病情较差，无法进行主-髂动脉手术。尽管1例患者因皮肤病变发展为坏疽而需要截肢，但未再发生栓塞事件，症状消失。讨论了抗凝药物在诱发动脉粥样硬化栓塞中的可能作用，并强调了识别该综合征的重要性。
