45 - Atheroembolism

Abstract

Atheroembolism is a rare systemic disorder occurring when tiny fragments of an atherosclerotic plaque (in particular, cholesterol crystals) break off from a proximal artery and travel distally in the circulation. The consequence of this event is microvascular obstruction in small arteries, resulting in tissue ischemia. Cholesterol embolization is associated with significant morbidity and mortality. Any organ may be involved, but the most common targets are the skin and kidneys. This results in clinically recognizable entities including livedo reticularis, the blue toe syndrome, and acute and chronic kidney failure. Atheroembolism can occur spontaneously but more commonly follows an invasive angiographic or endovascular procedure. Prompt diagnosis is imperative, and a high index of clinical suspicion is necessary as atheroembolism may mimic a number of other disorders, leading to potential misdiagnosis. There is no single definitive laboratory test. Confirmative diagnosis requires histological confirmation of cholesterol crystals in a biopsy of muscle, skin, or affected organ. Prognosis is determined by the extent of systemic involvement and risk of recurrent episodes. As in many vascular disorders, prevention is the best treatment.