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Trash feet after coronary angiography
1Department of Vascular Surgery, King George Hospital, Essex, UK. dramirkhan@hotmail.com
Heart (British Cardiac Society)
|April 16, 2003
Summary
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.