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  • Q&A with Australian Health Practitioners

    Rectify black & extremely painful toe after having angiogram - what can be done?

    Angiogram through groin, within 2 hours toe started to get extremely painful, has now been extremely painful for over 2 weeks and turning black - hospital has done ct scan - nothing obvious, said shards from angiogram have blocked toe. Can only sleep for about 2hrs then pain wakes them up. Pulse ok in lying position, weak in sitting position. Hospitals (2 of them) could not fix. What can be done?
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    Thanks

    Dr George Touma

    Cardiologist (Heart Specialist)

    Dr George Touma is an Australian trained Cardiologist with dual training in medicine and pharmacy. He has undergone sub-specialised training in interventional cardiology, with a ... View Profile

    Hello. Thanks you for your question. Sorry to hear about your symptoms.  

    A black and painful toe usually results from a problem called "cholesterol embolisation". 

    During an angiogram, cholesterol plaque can be dislodged and can travel through the body. It is a very rare complication. 

    Risk factors include 

    1. Advanced age 

    2. Diabetes 

    3. Smoking 

    4. Elevated weight 

    5. High cholesterol and or triglyceride levels 

    In mild cases the patient won't notice symptoms. In more significant cases, cholesterol travels and lodges in the small arteries in the toe and blocks blood flow making the toe change colour. The toe can be painful but will gradually get better. It can take a few weeks. The toe should gradually return to a normal colour and may become itchy or the skin may peel. You should see the GP every week while healing is occurring. 

    In severe cases, the kidneys can be affected and kidney function may deteriorate. Patients normally become very sick when this occurs and need to stay in hospital. 

    There are no specific treatments. I would use medications to open up the small arteries in the toes to help with healing. 

    Hope this information is helpful. 

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  • Dr Shannon Thomas

    Vascular Surgeon

    Dr Thomas is an Australian trained Vascular, Endovascular and Kidney Transplant Surgeon who holds appointments at the Prince of Wales Hospital in Sydney, and a ... View Profile

    It sounds like there has been a change in the blood flow to your leg. If the problem started after an angiogram, cholesterol embolisation is the most likely diagnosis.

    The traditional approach to this is to watch and wait and allow the body to heal the damage in the toe. More aggressive approaches these days involve performing an angiogram of the leg to identify the blocked artery in the leg/foot and quite simply unblock it. Unblocking may involve vacuuming the blockage out or placing a balloon or stent to restore the blood flow. If successfully performed, this can reduce pain and decrease time to healing.

    A vascular surgeon is best placed to assess the circulation of your leg and diagnose your condition. They will be able to advise if endovascular recanalisation of the vessels of the foot will help improve your condition

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