Cholesterol Embolism Medication

  • Author: Lisa Kirkland, MD, FACP, CNSP, MSHA; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Aug 31, 2011
 
 

Medication Summary

Medical therapy is not particularly successful in patients with cholesterol embolism syndrome. Vasodilator therapy with calcium channel blockers may help relieve the local ischemia resulting from vasospasm, but angiotensin-converting enzyme (ACE) inhibitors should not be used because of their negative effects on renal afferent arterioles and the glomerular filtration rate. Patients presumed to have vasculitis have been treated with high-dose steroids and antiinflammatory agents, with anecdotal reports of recovery. However, steroids may predispose patients to infectious, metabolic, and nutritional complications and difficulties with wound healing. The use of anticoagulants is controversial because anticoagulants and thrombolytics have been shown to induce atheroemboli. Anecdotal reports of treatment with apheresis, iloprost, statin, colchicine, or combinations of these drugs with steroids report improvement in some cases.

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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

References

  1. Jucgla A, Moreso F, Muniesa C. Cholesterol Embolism: Still an Unrecognized Entity with a High Mortality. J Am Acad Derm. 2006;55:786-793.

  2. Willens HJ, Kramer HJ, Kessler KM. Transesophageal echocardiographic findings in blue toe syndrome exacerbated by anticoagulation. J Am Soc Echocardiogr. Nov-Dec 1996;9(6):882-4. [Medline].

  3. Acarturk E, Ozeren A, Sarica Y. Detection of aortic plaques by transesophageal echocardiography in patients with ischemic stroke. Acta Neurol Scand. Aug 1995;92(2):170-2. [Medline].

  4. Adler Y, Shohat-Zabarski R, Vaturi M, Shapira Y, Ehrlich S, Jortner R. Association between mitral annular calcium and aortic atheroma as detected by transesophageal echocardiographic study. Am J Cardiol. Mar 15 1998;81(6):784-6. [Medline].

  5. Belenfant X, Meyrier A, Jacquot C. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Am J Kidney Dis. May 1999;33(5):840-50. [Medline].

  6. Carroccio A, Olin JW, Ellozy SH, Lookstein RA, Valenzuela R, Minor ME. The role of aortic stent grafting in the treatment of atheromatous embolization syndrome: results after a mean of 15 months follow-up. J Vasc Surg. Sep 2004;40(3):424-9. [Medline].

  7. Elinav E, Chajek-Shaul T, Stern M. Improvement in cholesterol emboli syndrome after iloprost therapy. BMJ. Feb 2 2002;324(7332):268-9. [Medline].

  8. Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A,. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol. Jul 16 2003;42(2):211-6. [Medline].

  9. Hasegawa M, Sugiyama S. Apheresis in the treatment of cholesterol embolic disease. Therap Apher Dial. Aug 2003;7(4):435-8. [Medline].

  10. Hirano Y, Ishikaw K. Cholesterol Embolization Syndrome: How to Recognize and Prevent This Potentially Catastrophic Iatrogenic Disease. Int Med. 2005;44:1209-1210.

  11. Katz ES, Tunick PA, Rusinek H, Ribakove G, Spencer FC, Kronzon I. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol. Jul 1992;20(1):70-7. [Medline].

  12. Keen RR, McCarthy WJ, Shireman PK, Feinglass J, Pearce WH, Durham JR. Surgical management of atheroembolization. J Vasc Surg. May 1995;21(5):773-80; discussion 780-1. [Medline].

  13. Kirkland L. Cholesterol embolism in intensive care patients. J Intensive Care Med. 1993;7(3):12-21.

  14. Kolh PH, Torchiana DF, Buckley MJ. Atheroembolization in cardiac surgery. The need for preoperative diagnosis. J Cardiovasc Surg (Torino). Feb 1999;40(1):77-81. [Medline].

  15. Lowe HC, Houser SL, Aretz T, MacNeill BD, Oesterle SN, Palacios IF. Significant atheromatous debris following uncomplicated vein graft direct stenting: evidence supporting routine use of distal protection devices. J Invasive Cardiol. Oct 2002;14(10):636-9. [Medline].

  16. Maki T, Izumi C, Miyake M, Izumi T, Takahashi S, Himura Y, et al. Cholesterol embolism after cardiac catheterization mimicking infective endocarditis. Intern Med. Oct 2005;44(10):1060-3. [Medline].

  17. Manganoni AM, Venturini M, Scolari F, Tucci G, Facchetti F, Graifemberghi S. The importance of skin biopsy in the diverse clinical manifestations of cholesterol embolism. Br J Dermatol. Jun 2004;150(6):1230-1. [Medline].

  18. Resnik KS. Intravascular cholesterol clefts as an incidental finding: cholesterol embolism or not?. Am J Dermatopathol. Dec 2003;25(6):497-9. [Medline].

  19. Ribakove GH, Katz ES, Galloway AC, Grossi EA, Esposito RA, Baumann FG. Surgical implications of transesophageal echocardiography to grade the atheromatous aortic arch. Ann Thorac Surg. May 1992;53(5):758-61; discussion 762-3. [Medline].

  20. Sanai T, Matsui R, Hirano T. LDL apheresis for cholesterol embolism following coronary artery bypass graft surgery--a case report. Angiology. May-Jun 2006;57(3):379-82. [Medline].

  21. Tenenbaum A, Garniek A, Shemesh J, Fisman EZ, Stroh CI, Itzchak Y. Dual-helical CT for detecting aortic atheromas as a source of stroke: comparison with transesophageal echocardiography. Radiology. Jul 1998;208(1):153-8. [Medline].

  22. Vayssairat M, Chakkour K, Gouny P, Nussaume O. Atheromatous embolisms and cholesterol embolisms: medical treatment [French]. J Mal Vasc. 1996;21 Suppl A:97-9. [Medline].

  23. Verneuil L, Ze Bekolo R, Dompmartin A, Comoz F, Marcelli C, Leroy D. Efficiency of colchicine and corticosteroids in a leg ulceration with cholesterol embolism in a woman with rheumatoid arthritis. Rheumatology (Oxford). Aug 2003;42(8):1014-6. [Medline].

  24. Frank RD, Velden J. Images in clinical medicine. Cholesterol emboli after coronary bypass surgery. N Engl J Med. Jan 20 2011;364(3):265. [Medline].

  25. Kronzon I, Saric M. Cholesterol embolization syndrome. Circulation. Aug 10 2010;122(6):631-41. [Medline].

  26. Brown PJ, Zirwas MJ, English JC 3rd. The purple digit: an algorithmic approach to diagnosis. Am J Clin Dermatol. 2010;11(2):103-16. [Medline].

 
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