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Cholesterol embolism as a complication of left heart catheterisation. Report of seven cases
Insights
Cholesterol embolism is a rare but serious complication following left heart catheterisation. This condition can lead to severe outcomes including renal failure and gangrene.
Area of Science:
- Cardiology
- Vascular Medicine
- Pathology
Background:
- Left heart catheterisation is a common diagnostic procedure.
- Complications, though rare, can significantly impact patient outcomes.
- Cholesterol embolism is a recognized, albeit infrequent, adverse event.
Purpose of the Study:
- To investigate the incidence and clinical presentation of cholesterol embolism.
- To identify risk factors associated with this complication.
- To describe the clinical course and outcomes of affected patients.
Main Methods:
- Retrospective analysis of 4587 left heart catheterisations.
- Identification of patients diagnosed with cholesterol embolism.
- Review of clinical data, laboratory findings, and autopsy results.
Main Results:
- Seven cases of cholesterol embolism were diagnosed (0.15% incidence).
- Common symptoms included acute limb/abdominal pain, renal failure, and cutaneous manifestations.
- Elevated erythrocyte sedimentation rate and eosinophilia were noted post-procedure.
Conclusions:
- Cholesterol embolism is a rare but serious complication of left heart catheterisation.
- Early recognition and management are crucial for improving patient prognosis.
- Atherosclerosis and anticoagulation may be associated risk factors.
Abstract:
Cholesterol embolism after left heart catheterisation by the femoral approach was diagnosed in seven men (mean age 59.6 years) out of a total of 4587 catheterisations. Diabetes was present in four patients, systemic hypertension in three, and signs of extensive atherosclerosis in six; five patients were taking anticoagulant drugs. Acute pain in the legs or abdomen occurred in six patients, two of whom had abdominal angina; renal failure was present in six patients, cutaneous manifestations in five, and a cholesterol embolus was seen in the retina in one. Six out of six patients had an appreciable increase in the erythrocyte sedimentation rate and five out of five had eosinophilia within a week of catheterisation. Renal failure was progressive in five patients, one of whom required haemodialysis. Three patients required amputation of the toes because of gangrene. Four patients died within four and a half months of catheterisation from causes not directly related to cholesterol embolism. At necropsy cholesterol emboli were found in all four patients. Cholesterol embolism is a rare but serious complication of left heart catheterisation.