Tratamiento combinado de enfermedad aórtica femoral con ateroembolismo distal: a propósito de un caso

Introduction. The 'blue toe syndrome' can be caused by the degeneration and rupture of an atherosclerotic plaque in the proximal arteries and the release of microemboli which progressively destroy distal circulation and may eventually lead to the loss of a limb. Besides treating the acute event and trying to salvage the affected tissue, the diagnostic and therapeutic efforts should be focused on locating and eliminating the source of the emboli. Nowadays, endovascular techniques offer new therapeutic possibilities with a less invasive approach than classical surgical procedures. Case report. A 74-year-old woman with atheroembolic lesions on her right foot in whom we found a severe calcified stenosis of the terminal aorta and a severe, irregular stenosis of the right common femoral artery. We treated the patient with a combined approach: transluminal angioplasty + stent-graft on the aortic lesion, and femoral endarterectomy and dacron patch angioplasty. We completed the treatment with intravenous alprostadil and a minor amputation of the 4th right toe. A year later the patient remains asymptomatic, with no abnormal vascular findings and normal duplex-scan controls. Conclusions. Endovascular techniques offer a useful and less invasive therapeutic possibility even in complex lesions. The combined and simultaneous treatment of multilevel atheromatous stenotic and atheroembolic plaques has proved a safe and effective option in our patient. [ANGIOLOGIA 2008; 60: 135-40]