An Institutional Experience With Arterial Atheroembolism

Seemingly minor blue-toe lesions resulting from atheroemboli are associated with unstable atherosclerotic plaques, which are at risk for causing recurrent emboli, tissue loss, and potentially death. At Washington University Medical Center, 62 patients (31 males and 31 females), ranging in age from 38 to 89 years (mean 62.8 ± 11.7 years), were treated for cutaneous manifestations of atheroembolic disease. Most patients (62%) had spontaneous bouts of atheroembolism, but 13 (21%) had recently undergone an inciting invasive radiologic study, 10 (16%) were on anticoagulation therapy, and one (2%) experienced abdominal trauma. In addition to the cutaneous manifestations, 18 patients (29%) also developed coincidental deterioration in renal function and four (6%) had intestinal infarction from atheroemboli. Arteriography in nearly all patients (97%) implicated the aorta and iliac arteries most commonly (80%), with the femoral (13%), popliteal (3%), and subclavian (3%) arteries less frequently incriminated. Forty-two patients underwent bypass grafting procedures (36 anatomic and six extra-anatomic) after exclusion of the native diseased artery, 20 patients had endarterectomies (six with additional bypass grafts), and five patients had no corrective vascular procedures. The 30-day operative mortality rate was 5% in this series. Nineteen patients (31%) required minor amputations, whereas two required major leg amputations. Thus limb salvage was possible in 86 of 88 (98%) limbs. No further episodes of atheroembolism occurred in the Involved limbs during follow-up (1 to 53 months, mean 20.2 months). We advocate urgent arteriography and surgical correction or bypass with exclusion of the offending lesion. This aggressive approach results in maximal limb salvage, low operative mortality, and excellent long-term relief of embolization.