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KMID : 0928520090190030261
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Korean Journal of Lipidology
2009 Volume.19 No. 3 p.261 ~ p.269
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Blue Toe Syndrome: A Single Center Experience Over 15 Year Period
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Park Ji-han
Lee Sang-yeub
Yang Ji-hyun
Noh Hye-jin
Cho Hyun-chul
Choi E-Ryoung
Jang Shin-yi
Lee Jung-Eun
Choi Seung-hyuk
Kim Duk-Kyung
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Abstract
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Background: Blue toe syndrome is an uncommon cutaneous manifestation of cholesterol embolization caused by distal showering of cholesterol crystals after angiography, vascular surgery or anticoagulation. We sought to evaluate the clinical manifestation and clinical outcomes of the Korean patients with blue to syndrome.
Methods: We enrolled 26 patients (mean age : 62.3±10.4 years, 22 men) who were diagnosed with blue toe syndrome in Samsung Medical Center from 1994 to 2008.
Results: Twenty patients (76.9%) was precipitated by vascular manipulation during angiography or surgery and 6 (23.1%) had no triggering events. Blue toe syndrome occurred within 23 days (Range 0~69) after the triggering events. The prevalence of eosinophilia (>500 /uL) was 61.5% and the mean eosinophil count was 624±418 /uL. Eosinophil count reached peak level within 3 weeks and decreased beyond 4 weeks after triggering events. The complex plaque (>4 mm or ulcerative) was found in 16 patients (61.5%) on Transthoracic echocardiography (TTE) and Computed tomography (CT) angiography. During the clinical follow-up (median duration of 5 months), 2 patients (7.7%) died, 7 patients (26.9%) required dialysis and 3 patients (11.5%) experienced limb loss. The group with clinical events including limb loss, new dialysis and death had lower baseline glomerular filtration rate (GFR), compared with no events group (P=0.015).
Conclusion: Blue toe syndrome is relatively rare but has serious complications including amputation, new dialysis and death in Korean patients. Decreased baseline GFR might be associated with subsequent clinical events during clinical follow-up.
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KEYWORD
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Angiograph, Angioplasty, Blue toe syndrome, Cholesterol embolization syndrome
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