Multiple spontaneous small bowel perforations due to systemic cholesterol atheromatous embolism.
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A-65-year-old man was admitted for coronary and peripheral angiography to evaluate angina pectoris and peripheral vascular disease. Following angiography, he suffered from blue toes, livedo reticularis and progressive renal failure. The patient's condition continued to deteriorate, including the development of malnutrition. Four months later he suddenly developed panperitonitis, went into shock and died. The autopsy verified multiple perforations of the small bowel with disseminated cholesterol atheromatous embolism. The other organs including kidney were also invaded by atheroembolism. This was a rare case of multiple spontaneous perforations of small bowel due to systemic cholesterol atheromatous embolism. (+info)
Thigh isosulfan blue injection in the treatment of postoperative lymphatic complications.
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Postoperative lymphatic complications after infrainguinal revascularization are troublesome and potentially serious complications. Vital dye injection into the web spaces of the foot has been recommended as a simple and reliable method to identify lymphatic channel disruption before groin exploration. Such distal injections, however, are not always successful. We describe a modified technique using a proximal thigh injection with isosulfan blue, which is faster and more useful than the distal web space method. (+info)
Cholesterol embolism in a patient with inflammatory abdominal aortic aneurysm.
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A 66-year-old man whose renal function had progressively deteriorated had an elevated blood pressure and also was found to have an inflammatory abdominal aortic aneurysm (AAA). Blood examination revealed that he had eosinophilia. Livedo reticularis of the toes developed, and a skin biopsy specimen showed embolization of atheromatous plaques in the arterioles of the subcutaneous tissue. Progressive enlargement of inflammatory AAA may have dislodged the atheromatous plaques, resulting in cholesterol embolism. (+info)
Aortic atherosclerotic debris detected by trans-oesophageal echocardiography--a risk factor for cholesterol embolization.
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The clinical syndrome of cholesterol embolization is uncommon but is associated with a poor prognosis. Patients with severe atheromatous disease of the aorta appear to be at particular risk from cholesterol embolization, particularly following vascular instrumentation or surgery. Trans-oesophageal echocardiography is the investigation of choice for imaging atherosclerotic disease of the aorta, and may be useful in assessing the risk of vascular procedures, and diagnostically helpful in patients with suspected cholesterol emboli syndrome. We report five cases of athero-embolism, and illustrate the role of trans-oesophageal echocardiography in making a diagnosis of cholesterol embolization. (+info)
Role of the distal balloon protection technique in the prevention of cerebral embolic events during carotid stent placement.
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BACKGROUND AND PURPOSE: We sought to quantitatively and qualitatively evaluate the release of atheromatous plaque debris induced by carotid stenting procedures. METHODS: Eight patients with severe carotid atheromatous stenoses were treated by stent implantation under distal balloon protection. Blood samplings were obtained after stent deployment in the blood pooled below the inflated protection balloon. The samples were centrifuged and evaluated for plaque debris with the use of light microscopy. The debris release was quantitatively estimated by dividing the total volume of debris obtained by the mean debris size. Five patients without endovascular procedure were used as a control group. RESULTS: The 2 main debris types found were nonrefringent cholesterol crystals (4 to 389 microm; 115 to 8697 in number) and lipoid masses (7 to 600 microm; 341 to 34 000 in number). There was a statistically significant difference compared with the samples obtained in the control group (P:=0.017). CONCLUSIONS: Blood samples collected during stent implantation procedures contain a large quantity of atheromatous plaque debris. This emphasizes the role of distal protection techniques in avoiding migration of this plaque material into the cerebral circulation. (+info)
Systemic cholesterol crystal embolisation with pulmonary involvement: a fatal combination after coronary angiography.
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Cholesterol crystal embolisation (CCE) is a rare but serious complication of invasive arterial procedures associated with a high mortality, and is a condition that medical staff undertaking invasive vascular procedures should be aware of. It is manifest as a multisystem disorder commonly involving the kidneys and peripheries, but rarely affecting the lungs. A case of fatal CCE with pulmonary involvement is reported, and similar published case reports are reviewed. The pathogenesis of lung involvement in CCE is unclear, but the combination is reported to be invariably fatal. (+info)
Endovascular treatment of embolization of aortic plaque with covered stents.
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Spontaneous atheroembolization from aortic plaque can lead to organ dysfunction and limb loss. With discrete offending lesions, surgical treatment has been recommended. Although endovascular treatment with angioplasty or stenting has been reported, concerns about destabilizing atheromatous material with catheter manipulation are well founded. Covered stents may obviate this risk. We report herein two patients with embolizing infrarenal aortic plaque successfully treated with these devices. (+info)
Atheroembolization: a harmful complication of therapeutic internal iliac artery occlusion.
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Coil embolization of the internal iliac artery (IIA) for proper endovascular treatment of aortoiliac aneurysms is a procedure with an acceptable morbidity rate consisting of buttock claudication in 12% to 55% and erectile dysfunction in 1% to 13%. Atheroembolic complications in this context are not yet reported. We present a case with gangrene of the prepuce and focal cutaneous necrosis of the ipsilateral buttock and foot after coil embolization of one IIA. Multiple atheroemboli were found with the histopathologic examination of the excised prepuce. Atheroembolization is a rare complication of therapeutic IIA occlusion, and the ischemic sequels can be severe because of the coincidence of atheroembolization and occlusion of the main supplying artery. (+info)