Applebaum R M, Kronzon I
New York University School of Medicine, Tisch Hospital, NY 10016, USA.
Curr Opin Cardiol. 1996 Sep;11(5):533-42. doi: 10.1097/00001573-199609000-00013.
The blue toe syndrome is characterized by tissue ischemia secondary to cholesterol crystal or atherothrombotic embolization leading to occlusion of small vessels. Embolization occurs typically from an ulcerated atherosclerotic plaque located in the aorto-iliac-femoral arterial system. Clinical presentation can range from a cyanotic toe to a diffuse multiorgan systemic disease that can mimic other systemic illness. Mortality can be higher than 70% depending on the scope of the illness. Embolization can occur spontaneously or from a variety of insults such as invasive vascular procedures, anticoagulation, or thrombolytic therapy. Angiography, duplex ultrasonography, computerized tomographic scanning, and magnetic resonance imaging have been used to image the offending lesions, with angiography considered the "gold standard" despite its inherent risks. Recently, transesophageal echocardiography has been shown to be a helpful tool in imaging the thoracic aorta and delineating in great detail the anatomy of the aortic atheroma. At present, surgery remains the most viable treatment option. However, we look to the future for large randomized trials to help predict embolization and thus the proper medical therapy.
蓝趾综合征的特征是继发于胆固醇结晶或动脉粥样硬化血栓栓塞的组织缺血，导致小血管闭塞。栓塞通常源于位于主动脉 - 髂动脉 - 股动脉系统的溃疡性动脉粥样硬化斑块。临床表现范围从青紫的脚趾到可模仿其他全身性疾病的弥漫性多器官系统性疾病。根据病情范围，死亡率可能高于70%。栓塞可自发发生，也可由各种损伤引发，如侵入性血管操作、抗凝或溶栓治疗。血管造影、双功超声、计算机断层扫描和磁共振成像已用于对致病病变进行成像，尽管血管造影有其固有风险，但仍被视为“金标准”。最近，经食管超声心动图已被证明是一种有助于对胸主动脉成像并详细描绘主动脉粥样瘤解剖结构的工具。目前，手术仍然是最可行的治疗选择。然而，我们期待未来有大型随机试验来帮助预测栓塞情况，从而确定合适的药物治疗方法。
