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Blue-tinged toes

  • Kevin J. O’Leary
    Correspondence
    Requests for reprints should be addressed to Kevin J. O’Leary, MD, Associate Division Chief for Hospital Medicine, Division of Internal Medicine, 675 North St. Clair, Suite 18-200, Chicago, IL 60611, Tel: (312) 695-8630, Fax: (312) 695-2857.
    Affiliations
    Division of General Internal Medicine, Feinberg School of Medicine of Northwestern University, Chicago, Ill.
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  • Keren Horn
    Affiliations
    Department of Dermatology, Feinberg School of Medicine of Northwestern University, Chicago, Ill.
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      A 64-year-old man with a history of peripheral vascular disease and hypertension presented to the emergency department with a 10-day history of bilateral toe pain. Six weeks earlier, he had been admitted to the hospital with chest pain. At that time, he was diagnosed with an acute myocardial infarction, and he underwent angioplasty with stent placement. During his hospital stay, the patient complained of worsening right lower-extremity claudication. Angiography indicated right superficial femoral artery occlusion. He was started on warfarin with a plan to perform lower-extremity revascularization at a future date.
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      References

        • Creager M.A.
        • Libby P.
        Peripheral arterial disease.
        in: Braunwald E. Zipes D. Libby P. Heart Disease. 6th ed. Saunders, Philadelphia, PA2001: 1477-1478
        • Saklayen M.G.
        • Gupta S.
        • Suryaprasad A.
        • Azmeh W.
        Incidence of atheroembolic renal failure after coronary angiography.
        Angiology. 1997; 48: 609-612
        • Fukumoto Y.
        • Tsutsui H.
        • Tsuchihashi M.
        • Masumoto A.
        • Takeshita A.
        The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization.
        J Am Coll Cardiol. 2003; 42: 211-216
        • Bashore T.M.
        • Gehrig T.
        Cholesterol emboli after invasive cardiac procedures.
        J Am Col Cardiol. 2003; 42: 217-218
        • Ramirez G.
        • O’Neill W.M.
        • Lambert R.
        • Bloomer H.A.
        Cholesterol embolization.
        Arch Intern Med. 1978; 138: 1430-1432
        • Moolenaar W.
        • Lamers C.B.
        Cholesterol crystal embolization in the Netherlands.
        Arch Intern Med. 1996; 156: 653-657
        • Thadhani R.I.
        • Camargo C.A.
        • Xavier R.J.
        • Fang L.S.
        • Bazari H.
        Atheroembolic renal failure after invasive procedures.
        Medicine. 1995; 74: 350-358
        • Blackshear J.L.
        • Zabalgoita M.
        • Pennock G.
        • Fensler P.
        • Strauss R.
        • Halperin J.
        • et al.
        Warfarin safety and efficacy in patients with thoracic aortic plaque and atrial fibrillation.
        Am J Cardiol. 1999; 83: 453-455
        • Wong F.K.
        • Chan S.K.
        • Ing T.S.
        • Li C.S.
        Acute renal failure after streptokinase therapy in a patient with myocardial infarction.
        Am J Kidney Dis. 1995; 3: 508-510
        • Wright D.A.
        • Forni L.G.
        • Carr P.
        • Hilton P.J.
        • Tungekar M.F.
        Cholesterol embolization after systemic streptokinase.
        Br J Hosp Med. 1997; 57: 51-52
        • O’Keeffe S.T.
        • Woods B.O.
        • Breslin D.J.
        • Tsapatsaris N.P.
        Blue toe syndrome.
        Arch Intern Med. 1992; 152: 2197-2202
        • Blankenship J.C.
        • Butler M.
        • Garbes A.
        Prospective assessment of cholesterol embolization in patients with acute myocardial infarction treated with thrombolytic vs. conservative therapy.
        Chest. 1995; 107: 662-668
        • Scolori F.
        • Ravani P.
        • Pola A.
        • Guerini S.A.
        • Zubani R.
        • Movilli E.
        • et al.
        Predictors of renal and patient outcomes in atheroembolic renal disease.
        J Am Soc Nephrol. 2003; 14: 1584-1590
        • Mann S.J.
        • Sos T.A.
        Treatment of atheroembolism with corticosteroids.
        Am J Hypertens. 2001; 14: 831-834
        • Carr M.E.
        • Sanders K.
        • Todd W.M.
        Pain relief and clinical improvement temporally related to the use of pentoxifylline in a patient with documented cholesterol emboli – a case report.
        Angiology. 1994; 45: 65-69
        • Elinav E.
        • Chajek-Shaul T.
        • Stern M.
        Improvement in cholesterol emboli syndrome after iloprost therapy.
        BMJ. 2002; 324: 268-269