Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1984 Sep;52(3):339–342. doi: 10.1136/hrt.52.3.339

Cholesterol embolism as a complication of left heart catheterisation. Report of seven cases.

H Drost, B Buis, D Haan, J A Hillers
PMCID: PMC481636  PMID: 6466520

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.

Full text

PDF
339

Images in this article

341Image
on p.341

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson W. R., Richards A. M., Weiss L. Hemorrhage and necrosis of the stomach and bowel due to atheroembolism. A correlative study of atheromatous emboli to the gastrointestinal tract in humans and experimental animals. Am J Clin Pathol. 1967 Jul;48(1):30–38. doi: 10.1093/ajcp/48.1.30. [DOI] [PubMed] [Google Scholar]
  2. Berkman M., Berkman N., Favre M., Seban C., Chiche P. Les embolie de cholestérol. Confrontation clinique, ophtalmoscopique et anatomique, à l'occassion de trois observations. Nouv Presse Med. 1972 Mar 18;1(12):795–800. [PubMed] [Google Scholar]
  3. Bourassa M. G., Noble J. Complication rate of coronary arteriography. A review of 5250 cases studied by a percutaneous femoral technique. Circulation. 1976 Jan;53(1):106–114. doi: 10.1161/01.cir.53.1.106. [DOI] [PubMed] [Google Scholar]
  4. Brenowitz J. B., Edwards W. S. The management of atheromatous emboli to the lower extremities. Surg Gynecol Obstet. 1976 Dec;143(6):941–945. [PubMed] [Google Scholar]
  5. Davis K., Kennedy J. W., Kemp H. G., Jr, Judkins M. P., Gosselin A. J., Killip T. Complications of coronary arteriography from the Collaborative Study of Coronary Artery Surgery (CASS). Circulation. 1979 Jun;59(6):1105–1112. doi: 10.1161/01.cir.59.6.1105. [DOI] [PubMed] [Google Scholar]
  6. Flory C. M. Arterial Occlusions Produced by Emboli from Eroded Aortic Atheromatous Plaques. Am J Pathol. 1945 May;21(3):549–565. [PMC free article] [PubMed] [Google Scholar]
  7. Formanek G., Frech R. S., Amplatz K. Arterial thrombus formation during clinical percutaneous catheterization. Circulation. 1970 May;41(5):833–839. doi: 10.1161/01.cir.41.5.833. [DOI] [PubMed] [Google Scholar]
  8. Gwost J., Stoebe T., Chesler E., Weir E. K. Analysis of the complications of cardiac catheterization over nine years. Cathet Cardiovasc Diagn. 1982;8(1):13–21. doi: 10.1002/ccd.1810080104. [DOI] [PubMed] [Google Scholar]
  9. Harrington D., Amplatz K. Cholesterol embolization and spinal infarction following aortic catheterization. Am J Roentgenol Radium Ther Nucl Med. 1972 May;115(1):171–174. doi: 10.2214/ajr.115.1.171. [DOI] [PubMed] [Google Scholar]
  10. Harrington J. T., Sommers S. C., Kassirer J. P. Atheromatous emboli with progressive renal failure. Renal arteriography as the probable inciting factor. Ann Intern Med. 1968 Jan;68(1):152–160. doi: 10.7326/0003-4819-68-1-152. [DOI] [PubMed] [Google Scholar]
  11. Haygood T. A., Fessel W. J., Strange D. A. Atheromatous microembolism simulating polymyositis. JAMA. 1968 Feb 5;203(6):423–425. [PubMed] [Google Scholar]
  12. Hertzer N. R. Peripheral atheromatous embolization following blunt abdominal trauma. Surgery. 1977 Aug;82(2):244–247. [PubMed] [Google Scholar]
  13. Judkins M. P. Percutaneous transfemoral selective coronary arteriography. Radiol Clin North Am. 1968 Dec;6(3):467–492. [PubMed] [Google Scholar]
  14. Kassirer J. P. Atheroembolic renal disease. N Engl J Med. 1969 Apr 10;280(15):812–818. doi: 10.1056/NEJM196904102801506. [DOI] [PubMed] [Google Scholar]
  15. Kennedy J. W. Complications associated with cardiac catheterization and angiography. Cathet Cardiovasc Diagn. 1982;8(1):5–11. doi: 10.1002/ccd.1810080103. [DOI] [PubMed] [Google Scholar]
  16. Kwaan J. H., Molen R. V., Stemmer E. A., Connolly J. E. Peripheral embolism resulting from unsuspected atheromatous aortic plaques. Surgery. 1975 Nov;78(5):583–588. [PubMed] [Google Scholar]
  17. Lonni Y. G., Matsumoto K. K., Lecky J. W. Postaortographic cholesterol (Atheromatous) embolization. Radiology. 1969 Jul;93(1):63–65. doi: 10.1148/23.1.63. [DOI] [PubMed] [Google Scholar]
  18. McKibbin D. W., Gott V. L., Hutchins G. M. Fatal cerebral atheromatous embolization after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1976 May;71(5):741–745. [PubMed] [Google Scholar]
  19. Moldveen-Geronimus M., Merriam J. C., Jr Cholesterol embolization. From pathological curiosity to clinical entity. Circulation. 1967 May;35(5):946–953. doi: 10.1161/01.cir.35.5.946. [DOI] [PubMed] [Google Scholar]
  20. Nachnani G. H., Lessin L. S., Motomiya T., Jensen W. N. Scanning electron microscopy of thrombogenesis on vascular catheter surfaces. N Engl J Med. 1972 Jan 20;286(3):139–140. doi: 10.1056/NEJM197201202860306. [DOI] [PubMed] [Google Scholar]
  21. Oostinga P., Thompson J., Noordhoek Hegt V., Eulderink F. Gedissemineerde cholesterolemboli; een ziektebeeld lijkend op polyarteriitis nodosa. Ned Tijdschr Geneeskd. 1978 Nov 4;122(44):1698–1701. [PubMed] [Google Scholar]
  22. Perdue G. D., Jr, Smith R. B., 3rd Atheromatous microemboli. Ann Surg. 1969 Jun;169(6):954–959. doi: 10.1097/00000658-196906000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Pierce J. R., Jr, Wren M. V., Cousar J. B., Jr Cholesterol embolism: diagnosis antemortem by bone marrow biopsy. Ann Intern Med. 1978 Dec;89(6):937–938. doi: 10.7326/0003-4819-89-6-937. [DOI] [PubMed] [Google Scholar]
  24. RICHARDS A. M., ELIOT R. S., KANJUH V. I., BLOEMENDAAL R. D., EDWARDS J. E. CHOLESTEROL EMBOLISM: A MULTIPLE-SYSTEM DISEASE MASQUERADING AS POLYARTERITIS NODOSA. Am J Cardiol. 1965 May;15:696–707. doi: 10.1016/0002-9149(65)90359-0. [DOI] [PubMed] [Google Scholar]
  25. Ramirez G., O'Neill W. M., Jr, Lambert R., Bloomer H. A. Cholesterol embolization: a complication of angiography. Arch Intern Med. 1978 Sep;138(9):1430–1432. [PubMed] [Google Scholar]
  26. Schechter D. C. Atheromatous embolization to lower limbs. N Y State J Med. 1979 Jul;79(8):1180–1186. [PubMed] [Google Scholar]
  27. Schinella R. A., Porensky R. Atheromatous emboli associated with external cardiac massage. Arch Pathol. 1974 May;97(5):319–322. [PubMed] [Google Scholar]
  28. THURLBECK W. M., CASTLEMAN B. Atheromatous emboli to the kidneys after aortic surgery. N Engl J Med. 1957 Sep 5;257(10):442–447. doi: 10.1056/NEJM195709052571002. [DOI] [PubMed] [Google Scholar]
  29. van der Hoek C., van Groenendael J. H., Gratama S. Cholesterolembolieën; een gegeneraliseerde ziekte met eosinofilie. Ned Tijdschr Geneeskd. 1979 Jun 16;123(24):1017–1020. [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES