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Severe systemic cholesterol embolization after open heart surgery
V Piriou1, J P Claudel, O Bastien
1Service d'Anesthésie et de Réanimation Post-opératoire, Hôpital Cardiologique Louis Pradel, Lyon, France.
Insights
Cholesterol crystal embolization (CCE) after coronary artery bypass grafting (CABG) is rare but severe. Patients presenting with CCE symptoms before surgery should avoid CABG due to poor prognosis.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Vascular Surgery
Background:
- Cholesterol crystal embolization (CCE) is a known complication of vascular procedures.
- Severe systemic CCE following coronary artery bypass grafting (CABG) is infrequently reported.
- CCE can manifest with multi-organ involvement, including cutaneous, renal, neurological, and hepatic systems.
Abstract:
Cholesterol crystal embolization (CCE) may be triggered by various factors: intra-arterial angiographic procedures, aortic or vascular surgery, anticoagulant or thrombolytic treatments, or both. There are few previous reports of patients undergoing coronary artery bypass grafting (CABG) experiencing and therefore displaying severe systemic CCE. We describe four patients presenting, shortly after CABG, cutaneous, renal, neurological and hepatic signs related to severe CCE confirmed by skin biopsy. All patients died 11-92 days after surgery. As systemic CCE reveals severe atheromatous disease and is associated with a poor prognosis, it is advisable to avoid CABG in patients who present symptoms of CCE before surgery.