Page 39 - Virtual Vascular Vol 10
P. 39
Gangrene Toes
A 96-year old bedridden old lady with multiple co-morbidities is on chronic ventila-
tion for pneumonia in a private hospital. She developed these bilateral, patchy cy-
anotic changes of the toes of both feet.
The diffuse nature of these changes suggested a cause other than standard athero-
sclerotic disease. Examination showed good popliteal pulses bilaterally. These dif-
fuses necrotic patches over the toes are sometimes a result of small athero-emboli
from a proximal source (blue-toes), or digital vessel spasm from prolonged inotrope
usage. Generally conservative treatment is all that is needed.
Extensive investigations (like a CT angiogram, done in this patient) is probably not
necessary. The CTA ordered by her physician, as expected, showed largely normal
vessels and only some small vessel disease (next page).
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