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Trash feet after coronary angiography

A M Khan1, S Jacobs

  • 1Department of Vascular Surgery, King George Hospital, Essex, UK. dramirkhan@hotmail.com

Heart (British Cardiac Society)
|April 16, 2003
PubMed

Insights

Cholesterol crystal embolisation, a complication of cardiac catheterisation, can cause severe lower extremity issues. This underdiagnosed condition has a poor prognosis and high mortality rate.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Pathology

Background:

  • Coronary catheterisation is a common and generally safe procedure.
  • Cholesterol crystal embolisation (CCE) is an underdiagnosed complication.
  • This condition can arise following invasive vascular procedures.

Observation:

  • A patient developed severe lower extremity pain, ulceration, and gangrene after cardiac angiography.
  • Symptoms included painful "trash feet" and livedo reticularis.
  • The patient presented with the classic triad of pain, livedo reticularis, and intact peripheral pulses.

Findings:

  • Catheter manipulation during cardiac angiography led to occlusion of small arteries in the feet.
  • This occlusion was caused by cholesterol crystal embolisation.
  • The condition is characterized by emboli of cholesterol crystals lodging in small arteries.

Implications:

  • Cholesterol crystal embolisation has a high mortality rate, ranging from 75-80%.
  • Prognosis is poor and treatment remains supportive.
  • Despite the safety of cardiac catheterisation, serious and fatal complications like CCE can occur.

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