Images in Clinical Medicine

Peripheral Embolism from an Aortic-Arch Atheroma

James Sangyop Lee, M.D., and P.A.N. Chandraratna, M.D.

N Engl J Med 2003; 349:e23December 11, 2003

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Article

A 62-year-old man presented with a one-month history of pain in the toes of both feet and in the left fourth fingertip. Examination revealed gangrene of the fingertip and all five toes of the right foot (Panel A), as well as dry gangrene of the fourth and fifth toes of the left foot. He had palpable bilateral femoral, popliteal, posterior tibial, and radial pulses and a diminished dorsalis pedis pulse. An angiogram of the legs and feet revealed occlusion of both anterior tibial arteries. A transesophageal echocardiogram (Panel B) revealed an ulcerated plaque (PL) in the aortic arch (Ao), with an overlying mobile component (arrows). The patient underwent amputation of the affected toes, and therapy with clopidogrel and simvastatin was begun. At the six-month follow-up visit, he was free of recurrent embolic events.

Thromboembolism from an atheroma in the aortic arch is an important cause of stroke and peripheral embolism. Transesophageal echocardiography is the technique of choice for the diagnosis of aortic-arch atheroma.

James Sangyop Lee, M.D.
University of California, San Francisco, San Francisco, CA 94143

P.A.N. Chandraratna, M.D.
Long Beach Veterans Affairs Medical Center, Long Beach, CA 90822

Citing Articles (6)

Citing Articles

1. 1

   John Alfred Carr, Stephan Wyers, Jai S. Raman. (2005) Complex Aortic Atheroma with Mobile Thrombus. Journal of the American College of Surgeons 201:6, 990-991
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2. 2

   Thein Htay, Ming W Liu. (2005) Drug-eluting stent: a review and update. Vascular Health and Risk Management 1:4, 263-276
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3. 3

   Lisette Okkels Jensen, Per Thayssen, Eli Kassis, Klaus Rasmussen, Kari Saunamäki, Leif Thuesen. (2005) Target vessel revascularization following percutaneous coronary intervention. A 10-year report from the Danish Percutaneous Transluminal Coronary Angioplasty Registry. Scandinavian Cardiovascular Journal 39:1-2, 30-35
   CrossRef

4. 4

   Lars Grip. (2005) A cath lab hero is something to be? Comments on left main stem percutaneous coronary intervention for ST-elevation myocardial infarction. Scandinavian Cardiovascular Journal 39:1-2, 6-9
   CrossRef

5. 5

   Malcolm R Macleod, Pierre Amarenco, Stephen M Davis, Geoffrey A Donnan. (2004) Atheroma of the aortic arch: an important and poorly recognised factor in the aetiology of stroke. The Lancet Neurology 3:7, 408-414
   CrossRef

6. 6

   Beckman, Joshua A., Gerhard-Herman, Marie, . (2004) Peripheral Embolism from an Aortic-Arch Atheroma. New England Journal of Medicine 350:14, 1472-1472
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