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Cholesterol Embolism: Follow-up

Author: Lisa Kirkland, MD, FACP, CNSP, MSHA, Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital
Contributor Information and Disclosures

Updated: Nov 2, 2009

Follow-up

Deterrence/Prevention:

  • If an invasive radiologic procedure is necessary, the risk of inducing cholesterol embolism must be considered. If the patient is at high risk, with known or suspected severe aortic atherosclerosis or aortic aneurysm, the Judkins (ie, brachial) or a radial artery approach may be used for introducing the catheter into the aorta. However, some investigators found the approach made no difference, leading them to suspect the ascending aorta as a major source of atheroemboli.
  • Gentle handling of the severely diseased aorta during cardiac or aortic surgery can reduce the risk of cholesterol embolism. Careful clamping techniques and careful selection of aortotomy sites may minimize disruption of the atherosclerotic plaque.

Complications:

  • Cholesterol embolism can directly affect all organs except the lungs, resulting in complications that range from mild dysfunction to complete organ failure.
  • Supportive care of organ dysfunction may be necessary and may include hemodialysis, bowel resection, cholecystectomy, and pancreatitis management.

Prognosis:

  • Patients with multisystem cholesterol embolism syndrome have a poor prognosis. As many as 90% die within 3 months.
  • Cholesterol crystal showers can become stabilized, leaving patients with varying degrees of organ dysfunction. Renal function can recover if no further insults occur, even to the degree that dialysis can be discontinued. However, patients remain at risk for recurrence of emboli.

Patient Education:

Miscellaneous

Medicolegal Pitfalls

As with most complications, a bad result may provoke legal action. Allegations of inappropriate, inadequate, or untimely management often cause liability. If an invasive arterial procedure is indicated and if a complication such as cholesterol embolism syndrome occurs, the physician must promptly recognize the problem and take appropriate action.

 


More on Cholesterol Embolism

Overview: Cholesterol Embolism
Differential Diagnoses & Workup: Cholesterol Embolism
Treatment & Medication: Cholesterol Embolism
Follow-up: Cholesterol Embolism
Multimedia: Cholesterol Embolism
References
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References

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Further Reading

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Keywords

cholesterol, embolism, cholesterol embolism, cholesterol embolism syndrome, CES, atheroembolism, trash foot syndrome, hypertension, HT, distal ischemia, cholesterol crystals, cholesterol plaques, atherosclerotic plaque, atheroembolic events

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Contributor Information and Disclosures

Author

Lisa Kirkland, MD, FACP, CNSP, MSHA, Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital
Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard M Stillman, MD, FACS, Honorary Medical Staff, Northwest Medical Center; Former Chief of Staff and Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center
Richard M Stillman, MD, FACS is a member of the following medical societies: American College of Angiology, American College of Surgeons, Association for Academic Surgery, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Travis J Phifer, MD, Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport
Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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