Severe systemic cholesterol embolization after open heart surgery

• Published in: British Journal of Anaesthesia Vol. 77; no. 2; pp. 277 - 280
• Main Authors: Piriou, V, Claudel, J P, Bastien, O, Ross, S, Lehot, J J
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford Elsevier Ltd 01-08-1996; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Aged; Arteriosclerosis - complications; Biological and medical sciences; Contraindications; Coronary Artery Bypass - adverse effects; Embolism, Cholesterol - etiology; Fatal Outcome; Humans; Medical sciences; Middle Aged; Prognosis; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Heart; Case study; Human; Surgery; Cardiovascular disease; Complication; Atheroma embolism
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/77.2.277

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.