Symmetrical Peripheral Gangrene

To the Editor.–Symmetrical peripheral gangrene as a complication of hypotension and poor tissue perfusion was presented by Goodwin and Berne in the June Archives (108:780, 1974). We agree entirely with the authors' conclusions, particularly the need to recognize the syndrome, thereby avoiding unnecessary angiography and surgical intervention. However, we wish to emphasize that symmetry is not an absolute prerequisite for the diagnosis of non-occlusive ischemia of the extremities. We have recently described our experience with asymmetrical non-occlusive ischemia of the lower extremities.¹ In all instances, the patient was admitted with the classic findings of unilateral embolic or thrombotic occlusion of a major limb vessel. Angiography was performed in these cases and showed complete patency of the arteries. However, the rate of filling and flow through the peripheral arterial system was extremely slow. In one of our cases, Doppler flowmeter recordings were helpful in that a flat tracing was