iloprost and Embolism--Cholesterol

Cholesterol crystal embolization (CCE) is a dreaded complication of radiology, vascular surgery, and/or anticoagulation in patients with atherosclerosis and ulcerated aortic plaques. It also represents a cause of early graft failure and of poor results of renal artery surgery. Crystals lodge in small caliber renal arteries, where they induce early, transitory thrombosis followed by delayed, definitive obstruction by endarteritis, accompanied by evidence of inflammation and eosinophilia. Massive CCE leads to early oligoanuria. In subacute forms, renal insufficiency is often delayed by weeks or months following the triggering event. A third, chronic subset of CCE is easily mistaken for atherosclerotic renal ischemia and/or nephrosclerosis. The kidney is rarely the sole organ involved in acute/subacute forms, in which the central nervous system, the coronary arteries, the spinal cord, and the mesenteric and pancreatic blood supply compromise represent the main causes of death. Cutaneous, retinal, and muscle involvement allow diagnosis by inspection or scarcely invasive biopsies in about 80% of cases, whereas renal biopsy as the only diagnostic procedure is required in 20% of cases. Prevention is based on avoidance of endovascular radiology maneuvers, vascular surgery, and excess anticoagulation in atherosclerotic patients. Treatment of acute/subacute forms of renal insufficiency consisting of stopping anticoagulation and forbidding any new radiologic and/or vascular surgery procedure; treating hypertension with angiotensin 2 antagonists and vasodilators, strict volemic control by loop diuretics and ultrafiltration, along with parenteral nutrition and prednisone, has been credited with improved outcome. Iloprost may obtain favorable results. Statins definitely ameliorate the renal and patient's prognosis.

Topics: Diagnosis, Differential; Embolism, Cholesterol; Humans; Iloprost; Nephrosclerosis; Renal Artery Obstruction; Treatment Outcome; Vasodilator Agents

Cholesterol atheroembolism (CAE) is a systemic disorder whose incidence has increased in recent decades and that presents high morbidity and mortality. Although several therapeutic alternatives have been reported, there is no consensus about the best treatment for this disease. In this paper we report the case of a patient with CAE with skin, bowel and kidney involvement who presented a good response to combined therapy with steroids and prostaglandin analogues. Although there are no conclusive studies, we recommend this therapeutic alternative in the management of CAE with organic failure.

Topics: Aged; Drug Therapy, Combination; Embolism, Cholesterol; Female; Humans; Iloprost; Steroids

Topics: Angioplasty, Balloon, Coronary; Embolism, Cholesterol; Humans; Hyperbaric Oxygenation; Iloprost; Male; Middle Aged; Myocardial Infarction; Necrosis; Peripheral Vascular Diseases; Platelet Aggregation Inhibitors; Stents; Tomography, X-Ray Computed

Topics: Aged; Atherosclerosis; Embolism, Cholesterol; Fatal Outcome; Humans; Iloprost; Male; Platelet Aggregation Inhibitors

Topics: Aged; Diagnosis, Differential; Embolism, Cholesterol; Humans; Iloprost; Male; Platelet Aggregation Inhibitors; Vasodilator Agents

Cholesterol embolism is a serious disease with a high morbidity and mortality rate. There is no clear evidence that any specific treatment helps this syndrome. We report a patient who developed acute renal failure due to cholesterol crystal embolism following percutaneous transluminal angioplasty of a renal artery. Treatment with iloprost for peripheral symptoms of cholesterol emboli resulted in rapid resolution of toe cyanosis, decrease in leg pain and a significant decrease in serum creatinine shortly after initiation of treatment. One month after initiation of iloprost therapy, skin signs of cholesterol emboli disappeared and leg pain diminished. Gradually reduction in serum creatinine level was also observed (from 390 to 160 micromol/L). Eighteen months after the arteriography, the patient had stable renal function with creatinine levels of 150-160 micromol/L, and he was asymptomatic.

Topics: Acute Kidney Injury; Angioplasty, Balloon; Embolism, Cholesterol; Follow-Up Studies; Humans; Iloprost; Male; Middle Aged; Renal Artery Obstruction; Vasodilator Agents

Topics: Aged; Aged, 80 and over; Catheterization; Coronary Angiography; Coronary Artery Bypass; Embolism, Cholesterol; Female; Humans; Iloprost; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Vasodilator Agents

Topics: Embolism, Cholesterol; Humans; Iloprost; Platelet Aggregation Inhibitors; Vasodilator Agents

The prognosis of cholesterol embolism is often poor, and no treatment is presently available. We report the use of a stable prostacyclin analogue in treating cholesterol embolism in a diabetic patient with arteriopathy. As a sole therapy, it improved cutaneous manifestations and pain, in parallel with an increased transcutaneous oxymetry. We think that prostacyclin analogues are novel candidates for the treatment of cholesterol embolism.

Topics: Aged; Crystallization; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Embolism, Cholesterol; Humans; Iloprost; Male