Introduction. Severe extremity ischemia and the presence of the ?blue-toe?
syndrome are rarely the first complications of the present abdominal aortic
aneurysm. We report two interesting cases of this rare entity. Outline of
Cases. A 61-year-old man presented with the rest pain of his toes
accompanied with digital ischemia of both feet. Physical examination
confirmed regular arterial pulses at lower extremities accompanied with
palpable pulsate mass in the abdomen. Vascular ultrasound and multidetector
tomography (MDCT) of blood vessels revealed small abdominal aortic aneurysm
(37 mm in diameter), filled with the irregular, ulcerated, heterogeneous
thrombotic masses. Aneurysm sac resection was performed with an
aorto-bi-iliac bypass reconstruction. A week later, it was mandatory to
amputate the fifth toe on the left foot because of the advanced gangrenous
process. The second case was a 77-year-old woman with 7-day history of
severe feet pain. Abdominal examination revealed pulsatile mass
paraumbilical to the left. Performed abdominal ultrasonography and MDCT
angiography confirmed coexistence of the infrarenal aortic aneurysm, 40.5 mm
in diameter, covered by significant mobile mural thrombus and ulcerations.
Surgical reconstruction was mandatory and patient underwent aneurysm sac
resection and aortobifemoral reconstruction. Conclusion. Embolic phenomenon
and peripheral embolic occlusion from the mural thrombus within the
abdominal aortic aneurysm are relatively rare events, but associated with
tissue loss. Thorough diagnostic examinations and prompt management are
required regardless of the aneurysm size once these signs occurred.
A Case of Blue Toe Syndrome and Myonephropathic Metabolic Syndrome with Abdominal Aortic Aneurysm.