EpistemisBuerger's sign (Paleness of elevation and blushing of dependence)
Specialty: Cardiovascular.
Why it occurs
- Severe obliterating peripheral arteriopathy
- Bilateral femoro-popliteal or aortoiliac occlusion
- Diabetic small vessel vasculopathy with critical tissue ischemia
- Advanced thromboangitis obliterans
- Peripheral microangiopathy due to connective tissue diseases with tissue ischemia
Initial workup
Measurement of ankle systolic pressure and calculation of the Ankle-Brachial Index (ABI) or measurement of the pressure of the first toe (in patients with non-compressible arteries due to calcification of the media layer); Arterial duplex Doppler ultrasound to evaluate high-resistance monophasic flows in distal arteries; Angio-CT of the lower limbs or Magnetic Resonance of peripheral vessels (Angio-MRI) to map the vascular tree and plan the revascularization strategy.
red flags
Extreme paleness on the sole of the foot that appears in less than 30 seconds after raising the limb to 45 degrees, followed by a dependency flush (intense red-purple discoloration, congested and painful when hanging the limb over the edge of the stretcher), associated with loss of fine sensitivity, delay in capillary refill (>5 seconds), marked skin coldness, persistent pain at rest or ulcerative lesions focal necrotic. Indicates a critically decreased arterial circulatory reserve, with risk of loss of limb viability.
Standard management
- Atorvastatin — to stabilize atheroma plaque and improve microvascular endothelial function; 80 mg once daily orally
- Acetylsalicylic acid — antiplatelet for secondary antithrombotic prophylaxis; 100 mg once a day
- Cilostazol — vasodilatory and antiplatelet agent indicated to improve collateral flow if there is no contraindication; 100 mg every 12 hours orally
- Pentoxyfylline (hemorheological agent to reduce blood viscosity and improve erythrocyte deformability; 400 mg three times a day orally with meals).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Cardiovascular
- Listed causes
- 5
- Treatment options
- 4