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Published on: September 15, 2023

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.

Journal of Cardiac Surgery
|March 12, 2002
PubMed

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.

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