Related Experiment Videos
[An autopsy case of renal failure due to cholesterol embolism following angiography]
Insights
Cholesterol embolism following angiography can lead to severe kidney damage and failure. This case highlights the lethal risks of cholesterol emboli, particularly in patients with pre-existing hypertension.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Interventional Radiology
Background:
- A 59-year-old male with a decade of hypertension presented with left shoulder pain, diminished left arm blood pressure, and visual field defects.
- Initial investigations revealed complete occlusion of the left subclavian artery orifice, despite normal coronary arteries.
Observation:
- Following cerebral artery angiography, the patient developed acute calf pain, blue toe syndrome, and progressive renal failure with significant proteinuria.
- Autopsy confirmed widespread cholesterol emboli in small arteries of visceral, urogenital, and thyroid organs, with severe cortical necrosis in the kidneys.
Findings:
- The patient's death from uremia three months post-angiography was attributed to extensive cholesterol embolism.
- Kidney damage from cholesterol emboli was the primary cause of mortality, characterized by irregular cortical necrosis.
Implications:
- This case underscores cholesterol embolism as a critical and potentially fatal complication of angiography.
- Awareness and early recognition are crucial for managing patients undergoing arterial procedures, especially those with risk factors like hypertension.
Abstract:
A 59-year-old man with a 10-year history of hypertension was admitted to the Osaka Medical College Hospital because of left shoulder pain, lower blood pressure in left arm, and nasal lower quadrant defect of the visual field of the left eye. After admission, he underwent coronary angiography and aortography. The examinations revealed that, although coronary arteries were normal, the orifice of the left subclavian artery was occluded almost completely. Two weeks after the examination, he underwent intra arterial DSA of the cerebral artery. After manipulation of the DSA, the patient complained of severe calf pain, developed blue toe and progressive renal failure with severe proteinuria. He died of uremia about three months after the DSA. Autopsy revealed multiple cholesterol emboli in small arteries in the visceral organs, urogenital organs and thyroid gland. In the kidneys, especially, damage by cholesterol emboli was large with irregular cortical necrosis. Examination of the brain was not permitted. This case shows that cholesterol embolism of the kidneys can be a lethal complication of angiography.