Cholesterol embolization syndrome
Cholesterol embolization syndrome is showering of cholesterol crystals from atherosclerotic plaques into small arteries, typically after an arterial procedure or anticoagulation. It causes livedo reticularis, blue toes with preserved pulses, and acute kidney injury; management is supportive with aggressive statin therapy and avoiding further arterial insult.
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What this article covers
- Overview
Definition: cholesterol embolization syndrome (atheroembolism) is the showering of cholesterol crystals from ulcerated atherosclerotic plaques into small distal arteries, causing ischemic and inflammatory end-organ injury.
- Epidemiology
Occurs in older patients with diffuse atherosclerosis.
- Risk factors
Severe diffuse atherosclerosis and aortic plaque.
- Pathophysiology
Plaque disruption: mechanical (catheter) or pharmacologic (anticoagulation, thrombolysis) disruption of an ulcerated plaque releases cholesterol crystals.
- Clinical features
Cutaneous: livedo reticularis, blue or purple toes, and digital gangrene with intact pulses.
- Differential diagnosis
Systemic vasculitis: overlapping skin and renal involvement with constitutional features, distinguished by positive vasculitis serologies (such as ANCA) and biopsy showing vessel-wall inflammation…
- Diagnosis
Establish clinically by the triad after a plaque-disrupting event, supported by eosinophilia and, when needed, biopsy showing cholesterol clefts: the diagnostic basis is the characteristic skin and…
- Management
First-line, supportive care with aggressive risk-factor and statin therapy, alongside supportive care of the affected organs (including renal support and wound care): High-intensity statin…
- Complications
Progressive or permanent renal impairment.
- Prognosis
Variable, with significant morbidity and mortality in severe multiorgan disease.
- Prevention
Minimize unnecessary arterial procedures in patients with severe atherosclerosis.
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