The

n e w e ng l a n d j o u r na l

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images in clinical medicine

Peripheral Artery Disease

B

69-year-old man presented with a 10-day history of discolor- Ho-Cheol Kang, M.D., Ph.D.
Min-Young Chung, M.D., Ph.D.
ation of the left foot and pain in the
leftAUTHOR
foot while
at rest. He reported
a 1-year
RETAKE
1st
Kang
ICM
2nd
history of intermittent claudication
left
leg.
His
medical
history
was
noREG in
F his
FIGURE
a&b
Chonnam National University
CASE
table for type 2 diabetes mellitus and hypertension.
foot 3rd
was Medical School
TITLE On examination, his left
Revised
EMail
4-C posterior tibi- Gwangju 501-746, South Korea
erythematous, cold to the touch, and pulseless
in the dorsalisLine
pedis and
SIZE
Enon
ARTIST: mst
H/T
H/T pale when el- drkang@chonnam.ac.kr
al arteries while hanging down (Panel FILL
A). However,
the foot
became
39p6
Combo
evated (Panel B) and became red again while hanging
down, which is Buergers sympAUTHOR, PLEASE NOTE:
has been
redrawn
and type
beensome
reset. signs
tom, suggesting the presence of peripheralFigure
artery
disease.
Both
feethashad
Please check carefully.
of arterial insufficiency, such as loss of hair and thin and dry skin, but there was no
pallor or cyanosis. Subsequent angiography
involving
JOB: showed
35718 severe arteriosclerosis
ISSUE: 11-1-07
the right and left external iliac arteries, with stenosis of 67% and 82%, respectively,
and total thrombotic occlusion of the left superficial femoral artery. Percutaneous
transluminal angioplasty, with stent insertion in both external iliac arteries and in
the left superficial femoral artery, restored the distal blood flow. After the procedure,
both the redness of the left foot and the ischemic symptoms resolved. Paradoxical
redness in patients with peripheral artery disease occurs with very restricted arterial
inflow and chronic dilatation of the peripheral vascular bed. The patient was well during the 3-year follow-up period, without recurrent symptoms of arterial insufficiency.
Copyright 2007 Massachusetts Medical Society.

n engl j med 357;18 www.nejm.org november 1, 2007

The New England Journal of Medicine

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Copyright 2007 Massachusetts Medical Society. All rights reserved.

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