Korean J Sports Med.  2022 Dec;40(4):259-262. 10.5763/kjsm.2022.40.4.259.

Premature Peripheral Arterial Disease with the 5th Toe Necrotizing Lesion after Workout: A Case Report

• Gwak HC
• Yoon JM
• Kim DY

• KMID: 2536677
• DOI: http://doi.org/10.5763/kjsm.2022.40.4.259

Abstract

Premature peripheral arterial disease is characterized by onset of peripheral arterial occlusion before age of 50 years. Its prevalence is rare. To the best of the authors’ knowledge, there is rare research of premature peripheral arterial disease in Korea. The authors encountered a case of necrotic toe caused by premature peripheral arterial disease after soccer workout. This paper reports this case with a review of the relevant literature.

Keyword

Peripheral arterial disease; Premature peripheral arterial disease; Atherosclerosis obliterans; Phalangectomy

Figure

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  Fig. 1 A 25-year-old male presented with the left 5th toe necrosis. (A, B) Lower extremity computed tomography angiography demonstrating complete occlusion at the left superficial femoral artery (arrows).

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  Fig. 2 Preoperative wound images. (A) A photograph of the initial wound after percutaneous transluminal angioplasty, thrombectomy, and endarterectomy. (B) After 1 week, it showed that the left 5th toe was completely necrotic and demarcated.

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  Fig. 3 (A) Postoperative radiograph showing the 5th toe proximal phalanx level amputated state. Clinical photograph shows the mild ulcerative lesion observed 2 months after surgery (B) and the clean wound observed 15 months after surgery (C).

Reference

1. Hirsch AT, Haskal ZJ, Hertzer NR, et al. 2006; ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; Trans-Atlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 113:e463–654. DOI: 10.1161/CIRCULATIONAHA.106.173994.

2. Valentine RJ, Jackson MR, Modrall JG, McIntyre KE, Clagett GP. 1999; The progressive nature of peripheral arterial disease in young adults: a prospective analysis of white men referred to a vascular surgery service. J Vasc Surg. 30:436–44. DOI: 10.1016/S0741-5214(99)70070-4. PMID: 10477636.

3. Barretto S, Ballman KV, Rooke TW, Kullo IJ. 2003; Early-onset peripheral arterial occlusive disease: clinical features and determinants of disease severity and location. Vasc Med. 8:95–100. DOI: 10.1191/1358863x03vm475oa. PMID: 14518611.

4. Norgren L, Hiatt WR, Dormandy JA, et al. 2007; Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 45 Suppl S:S5–67. DOI: 10.1016/j.jvs.2006.12.037. PMID: 17223489.

5. Mehta A, Dhindsa DS, Hooda A, et al. 2021; Premature atherosclerotic peripheral artery disease: an underrecognized and undertreated disorder with a rising global prevalence. Trends Cardiovasc Med. 31:351–8. DOI: 10.1016/j.tcm.2020.06.005. PMID: 32565142.

6. Ridker PM, Stampfer MJ, Rifai N. 2001; Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA. 285:2481–5. DOI: 10.1001/jama.285.19.2481. PMID: 11368701.

7. Conte MS, Pomposelli FB, et al. Society for Vascular Surgery Lower Extremity Guidelines Writing Group. 2015; Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 61(3 Suppl):2S–41S. DOI: 10.1016/j.jvs.2014.12.009. PMID: 25638515.

8. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2017; 2016 AHA/ACC Guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 69:1465–508. DOI: 10.1016/j.jacc.2016.11.008. PMID: 27851991.

9. Cho S, Lee SH, Joh JH. 2019; Risk factors for asymptomatic peripheral arterial disease in Korean population: lessons from a community-based screening. Ann Surg Treat Res. 97:210–6. DOI: 10.4174/astr.2019.97.4.210. PMID: 31620395. PMCID: PMC6779951.