What are cholesterol emboli?
Cholesterol emboli are small deposits of cholesterol that become lodged inside the blood vessels of the skin or other internal organs. This leads to a blockage of the flow of blood through small calibre arteries and causes malfunction or death of the tissue supplied by the affected blood vessels. The process is also called atheroembolism.
How common are cholesterol emboli?
Please discuss with your doctor for further information.
What are the symptoms of cholesterol emboli?
The two most classic constellations of symptoms are:
- Livedo reticularis, leg/foot pain, and good foot pulses
- Livedo reticularis, kidney impairment, and eosinophilia (high numbers of circulating eosinophils in the blood).
Over one-third of patients experience skin symptoms including livedo reticularis, gangrene, cyanosis (‘blue toe syndrome’ secondary to lack of oxygenated blood supply), ulceration, painful red nodules, and purpura (purple patches).
Cholesterol fragments blocking blood vessels to other organs may result in specific symptoms and signs:
- Acute renal failure (kidney), in 25-50% of cases
- Retinal ischaemia (eye)
- Intestinal infarction
Non-specific symptoms such as fever, myalgia (muscle ache), headache, and weight loss may be present. Interestingly, neither myocardial infarction (heart attack) nor stroke are typical manifestations of this syndrome.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes cholesterol emboli?
The cholesterol emboli originate from ulcerated arteriosclerotic plaques, which can release cholesterol fragments (emboli) into the bloodstream.
This may occur spontaneously, but procedures that disrupt the plaque surface such as angiography, angioplasty, vascular surgery, intra-aortic balloon pumps, and even cardiopulmonary resuscitation are known triggers. Studies suggest it may occur following up to 1% of vascular procedures.
Trauma to the abdomen can rarely precipitate this syndrome by disrupting arteriosclerotic plaques within the abdominal aorta.
Drugs that are used for thrombolysis (to reopen a clotted vessel following a heart attack or stroke) or anticoagulation (to thin the blood) may also predispose to embolisation of cholesterol from unstable plaques secondary to dissolution of the overlying blood clot, or haemorrhage of the arteriosclerotic plaque. The risk however is thought to be very low, and no casual relationship has been demonstrated.
The symptoms are usually noticed within hours to days following a procedure or thrombolysis but usually after 2 months of anticoagulant therapy.
What increases my risk for cholesterol emboli?
Those who have atherosclerosis are at risk of cholesterol emboli. This includes patients with ischaemic heart disease or peripheral vascular disease, as well as those with risk factors such as diabetes, high blood pressure, smoking, obesity, older age, and high levels of cholesterol in the blood.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How are cholesterol emboli diagnosed?
A high index of suspicion is required especially in a patient with known atherosclerosis who has developed the typical skin changes, kidney failure, abdominal pain or diarrhoea, following a vascular procedure.
Definitive diagnosis is made from a skin biopsy or a biopsy of other involved tissue. The biopsy should show diagnostic cholesterol crystals or clefts within the blood vessel wall, along with thrombi (blood clots). The clefts are spaces left by the crystals that have been washed out by the tissue fixation.
Blood tests show an eosinophilia in up to 80% of affected patients. Other changes that may be seen include:
- Raised white cell count and/or platelet count
- Microscopic blood in the urine or stool
- Elevated erythrocyte sedimentation rate (ESR)
- Deranged kidney function tests
- Raised amylase levels
- Decreased serum complement.
How are cholesterol emboli treated?
Once cholesterol emboli have occurred, procedures to prevent further embolisation such as removal or stenting of unstable atheromatous plaques may be considered. Drugs such as statins, iloprost, pentoxifylline, and steroids have been reported to have limited success to minimise organ damage.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage cholesterol emboli?
The following lifestyles and home remedies might help you cope with cholesterol emboli:
The best strategy is prevention of arteriosclerosis with control of vascular risk factors.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Cholesterol emboli https://www.dermnetnz.org/topics/cholesterol-emboli/ Accessed October 30, 2017
Cholesterol Emboli Syndrome http://circ.ahajournals.org/content/122/6/631 Accessed October 30, 2017
Review Date: October 31, 2017 | Last Modified: October 31, 2017