Cholesterol embolism
Cholesterol embolism (atheroembolism) refers to diffuse embolisation by atheromatous material from an atherosclerotic plaque (usually of the aorta). It can involve the skin, kidney, brain, eye and viscera. The clinical syndrome of cholesterol embolism can include severe digital ischaemia (particularly toes), livedo reticularis (a coarse netlike discolouration of the skin), claudication (but with intact pulses), accelerated hypertension, kidney failure, visceral ischaemia, ocular embolic symptoms, transient ischaemic attack and stroke.
Cholesterol embolism can follow an invasive vascular procedure (eg vascular surgery, angiography, angioplasty), trauma, anticoagulation or thrombolytic therapy; it can also occur spontaneously. The syndrome is characterised by a cluster of laboratory abnormalities including a high erythrocyte sedimentation rate (ESR), hypergammaglobulinaemia, reduced serum complement concentration (C3 and C4), eosinophilia and markers of kidney failure.
Cholesterol embolism confers a significant risk of adverse effects, and surgical intervention may be required; seek specialist advice. Treat complications such as elevated blood pressure and kidney failure; however, treatment is mainly supportive. Anticoagulant therapy is often stopped.