Multiple cholesterol emboli syndrome. Bowel infarction after retrograde angiography

The two patients described in this article are among the first to have been diagnosed with extensive bowel infarction as a result of cholesterol embolization following cardiac catheterization. The presence of acute hypertension, renal insufficiency, livedo reticularis, and gangrenous skin changes are characteristic manifestations of the multiple cholesterol emboli syndrome. Additionally, gastrointestinal symptoms and melena may herald ischemia and infarction of the alimentary tract. Anticoagulation and thrombolytic therapy are relatively contraindicated in this syndrome and may, in fact, be a precipitating cause. The prognosis is usually poor; however, survival is possible with aggressive medical and surgical therapy, despite extensive infarction of the gastrointestinal tract and other organs. Prevention remains the most critical aspect of management of this potentially catastrophic illness.