External iliac ligation and axillary-bifemoral bypass for blue toe syndrome.

Overview

BACKGROUND: This report describes six patients with atheroemboli to both lower extremities that originated from the abdominal aorta. All patients had severe bilateral rest pain and ulceration or gangrene. Each had severe coronary artery disease and other medical problems, which precluded direct aortic reconstruction. METHODS: Ligation of the external iliac arteries was performed to prevent continual passage of emboli into the lower extremities. Revascularization was effected by axillary-bifemoral bypass. RESULTS: Initial limb salvage was accomplished in twelve threatened extremities. One patient required a single toe amputation. One axillary graft failed after 3 months and was successfully replaced with a contralateral graft. These patients have been followed for up to 52 months without limb loss; the mean follow-up is almost 2 1/2 years. CONCLUSIONS: In patients with severe coronary artery disease and blue toe syndrome, the combination of external iliac ligation and axillary-bifemoral bypass is an effective and durable procedure to prevent worsening ischemia and to salvage threatened lower extremities.