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Disseminated cholesterol embolism after coronary artery bypass grafting
S Nakamoto1, T Kaneda, T Inoue
1Department of Cardiovascular Surgery, Kinki University School of Medicine, Osakasayama, Osaka, Japan.
Insights
Disseminated cholesterol embolism is a dangerous condition, even if blue toe syndrome is usually benign. This case highlights the risks of invasive procedures in high-risk patients, leading to fatal outcomes.
Area of Science:
- Cardiology
- Vascular Surgery
- Nephrology
Background:
- Cholesterol emboli can cause blue toe syndrome, typically a benign condition.
- Disseminated cholesterol embolism, however, represents a life-threatening systemic complication.
Observation:
- A 71-year-old female presented with chest pain and claudication, undergoing cardiac catheterization and warfarin therapy.
- Bilateral toe discoloration and rising BUN/creatinine levels suggested cholesterol emboli, improving after warfarin cessation.
- Postoperative cerebral infarction and renal failure occurred after coronary artery bypass grafting and femoropopliteal bypass.
Findings:
- Disseminated cholesterol embolism led to fatal renal failure and cerebral infarction in a patient with pre-existing cardiovascular disease.
- The patient's condition deteriorated despite surgical interventions, underscoring the severity of cholesterol emboli complications.
Implications:
- Avoid interventional procedures targeting the ascending aorta in high-risk patients.
- For coronary artery bypass grafting (CABG), consider off-pump techniques and arterial grafts to mitigate risks.
Abstract:
Blue toe syndrome caused by cholesterol emboli is a relatively benign disease. However, disseminated cholesterol embolism is a life-threatening condition. We describe here the case of a 71-year-old female admitted because of anterior chest pain and intermittent claudication. Following cardiac catheterization, warfarin potassium was administered. However, the patient's toes soon darkened bilaterally, and BUN and creatinine levels increased from the normal value. Skin discoloration and renal failure were improved after stopping warfarin potassium administration. The patient underwent coronary artery bypass grafting and left femoropopliteal bypass. Cerebral infarction and renal failure occurred postoperatively due to disseminated cholesterol embolism. The patient died from renal failure on the 16th postoperative day without regaining consciousness following surgery. For high risk patients, interventional procedures to the ascending aorta must be avoided. When CABG cannot be avoided for coronary revascularization, off-pump bypass and use of arterial grafts are recommended.