Cholesterol embolism or cholesterol embolism syndrome is a serious condition triggered by arterial stenosis and inflammation. This, in turn, is caused by cholesterol crystals being washed into the arteries, which are usually dissolved by surgical intervention (75%). The prognosis of cholesterol embolism is poor, as it often leads to chronic renal failure.
What is cholesterol embolism?
Cholesterol embolism occurs when cholesterol is released, usually from atherosclerotic plaque, and flows with the bloodstream to other parts of the body. There it becomes lodged and constricts blood vessels. Cholesterol embolism usually manifests itself in skin problems, gangrene (death of tissue), or kidney failure. Problems with other organs can also occur, depending on where in the body the cholesterol enters the bloodstream. Diagnosis is usually made by biopsy (removal and analysis of tissue) of the affected organ. Cholesterol embolism is treated by directly treating the causes and treating the accompanying symptoms. Statin drugs have shown positive results in treatment.
Causes
It is relatively uncommon for cholesterol embolism to occur suddenly (about 25% of all cases). This occurs mainly in people with advanced cases of atherosclerosis in large vessels, such as the aorta. In the other 75%, cholesterol embolism occurs from complications arising from treatments on the blood vessels; for example, angiography or vascular surgery. During coronary angiography, for example, the risk of such an embolism is 1.4%. Furthermore, a cholesterol embolism may develop after treatment with anticoagulants or thrombolytic drugs, which either increase the coagulation of the blood or dissolve clots. Such treatment may then lead to increased detachment of cholesterol, which then causes narrowing in the vessels elsewhere in the body.
Symptoms, complaints, and signs
A variety of symptoms can occur with a cholesterol embolism. However, these depend on which organs are affected. The prognosis of this disease is very poor. Acute or chronic renal failure is common. Another symptom is often reticular bluish-purple coloration of the skin. In addition, the so-called blue-toe syndrome can occur, which is characterized by circulatory disturbances in the toes. Among other things, small hemorrhages occur in the nail bed. In addition, the toes turn purple. The digestive system is also often affected. Thus, severe abdominal pain often occurs, caused by severe circulatory disturbances in this area. The severe pain is accompanied by nausea and vomiting. The stool is sometimes black in color due to gastric or intestinal bleeding. Often there is pancreatitis, which can lead to the destruction of the pancreas. If the musculoskeletal system is involved, joint and muscle pain occur. If the nervous system is involved, confusion, impaired consciousness and sometimes even temporary blindness often occur. Furthermore, stroke or stroke-like symptoms may also occur. Very often, general symptoms such as severe feeling of illness with fever and emaciation are also observed. One third of patients remain permanently dependent on dialysis. Deaths often occur due to circulatory failure, infection, internal bleeding in the gastrointestinal tract, or pancreatitis.
Diagnosis
Diagnosis of cholesterol embolism can be difficult because the symptoms of the complaint are very similar to those of others; for example, vasculitis or kidney problems. The cause of poor kidney values, which can be triggered by a cholesterol embolism, can also have many other causes. Blood and urine tests are performed in most cases. These may show inflammation, and in a blood count, elevated levels of white blood cells are found in 60% of cases of cholesterol embolism. The urine may show elevated levels of red blood cells and protein. The definitive diagnosis can only be made with a biopsy. In the tissue sample, the cholesterol crystals responsible for the cholesterol embolism can be identified by analysis.In some cases, even examination of the tissue is not definitive, but it can rule out other diseases (such as vasculitis).
Complications
In the worst case, cholesterol embolism can cause damage to organs. Usually, patients with this condition suffer from severe weight loss, which cannot be stopped with excessive food intake. Nausea and fever also occur, and most patients also complain of a loss of appetite. The quality of life is extremely reduced by the cholesterol embolism. Furthermore, various organs are damaged. In the worst case, the kidneys can also be affected, resulting in complete kidney failure. The central nervous system is also affected by cholesterol embolism, which can cause the patient to suffer sensory disturbances. Specific treatment of cholesterol embolism is not directly possible. It is mainly the symptoms and the damage to the different organs that are treated. Further spread of the disease must also be limited. If certain organs have already been damaged, transplantation may be necessary. In the case of renal insufficiency, the affected person is then dependent on dialysis. Furthermore, various drugs are used to counteract the symptoms. The further complications depend to a large extent on the damage to the respective organs. As a rule, life expectancy is reduced by the cholesterol embolism.
When should you see a doctor?
If abdominal pain, redness of the skin, and other typical signs of cholesterol embolism are repeatedly noticed, a visit to the doctor is recommended. Symptoms of renal insufficiency or reduced blood flow should be clarified immediately because of the potential complications. In any case, a physician must be consulted who can diagnose and treat the disease. In particular, high-risk patients – such as people with advanced cases of arteriosclerosis and patients who have undergone vascular surgery or angiography – should talk to the doctor in charge if they experience unusual symptoms. If the weight loss characteristic of cholesterol embolism causes discomfort, the appropriate physician should be consulted. A therapist should also be consulted, as the disease usually has a very negative effect on the quality of life. If kidney failure occurs, 112 must be dialed immediately. Depending on how severe the disease is, first aid measures must also be administered. In the event of kidney failure, a doctor must be consulted regularly. In case of complications, it is best to call the emergency number or go to the nearest hospital.
Treatment and therapy
Hemodynamic control, including catheterization of the pulmonary artery, may be useful for improvement of blood flow. If acute respiratory failure occurs, artificial ventilation may be necessary for a prolonged period. If decreased kidney function is found, dialysis may be needed. Consequently, measures to support the metabolism and artificial nutrition are also necessary, since affected persons can quickly lose body weight and vitality due to their situation. After a cholesterol embolism, inversive treatments on the vessels should be avoided, and the same applies to therapy with anticoagulants or thrombolytic drugs. If these therapies are unavoidable, extensive precautions should be taken to filter dislodging particles from the blood. More extensive surgery may be necessary to remove the sources of the clogging material, and placement of surgical stents is also a method of preventing emboli. Damaged tissue should be protected and given time to heal; chances of recovery are good. Dead tissue must be removed. In severe cases, lumbar sympathetic blockade may be used to stem tissue loss in the lower body.
Outlook and prognosis
The prognosis of cholesterol embolism is considered unfavorable. Because chronic renal failure occurs as the disease progresses, the mortality rate of patients is very high. Nevertheless, the outlook is highly dependent on the location of the vascular occlusion as well as other factors. More than 1/3 of all patients become permanent dialysis patients and have no prospect of recovery. In acute cases, they are at risk of life-threatening and premature death.Approximately 25% of patients die from cholesterol embolism within 2 years. Without medical care, death is significantly more likely to occur. The mortality rate increases in patients of advanced age and with other diagnosed diseases. There is a particularly poor outlook in sufferers of diabetes or heart failure. Because of the various patients at risk, the treatment of cholesterol embolism is often aimed at prolonging life while halting the progression of the disease. With a weakened immune system, the risk of infection increases, which is in addition to a poor prognosis. Patients have the best chance of recovery when they are in young to middle adulthood, have a healthy lifestyle, and have no other medical conditions. With timely medical treatment of cholesterol embolism, recovery can occur. These patients can also achieve improved health with a donor organ and transplant.
Prevention
Preventing a cholesterol embolism directly is difficult. It usually occurs in people who already have diseases that promote embolism. According to the current status, the risk factors are: male sex, hypertension, smoking, coronary heart disease, renal artery stenosis, cerebrovascular disease, arterial occlusive disease.
Follow-up
Follow-up care for cholesterol embolism includes a period of rest and close observation of physical symptoms. Patients must contact their physician immediately if there are any skin changes or evidence of renal failure. Depending on the cause of the disease, it may be possible to combat the triggers during follow-up care. This means, for example, a change in diet, which can also be useful if there is a genetic predisposition. Drug therapy helps to alleviate the symptoms. Diet is also recommended in many cases. As a result, the further prognosis for patients looks much more positive. In addition to the change in diet, the doctor advises more physical activity to prevent a possible relapse. Here, aftercare follows a similar path as prophylaxis. Depending on the severity of the disease, additional steps may take place as part of aftercare. In close consultation with the treating physician, patients learn more about how to improve their quality of life. Good self-monitoring helps to identify any risks at an early stage. Thus, consistent follow-up care helps contain the risk of the disease and improve quality of life.
Here’s what you can do yourself
If cholesterol embolism is suspected, the attending physician must first be informed. Self-help measures should be refrained from, since the condition can only be treated with medication. Accordingly, the most important accompanying measure is to take it easy and to inform the doctor of any unusual symptoms. If, for example, skin changes appear or signs of kidney failure appear, the physician must be informed immediately. In addition, the cause of the cholesterol embolism must be found. The medical diagnosis is supported by noting any triggers. Thus, diet should also be considered as a cause, as should pre-existing diseases or genetic predispositions. Once the diagnosis has been made, the physician can prescribe a drug from the substance class of statins and thereby alleviate the condition. Early diagnosis is crucial for a positive outcome. Patients need to talk to their doctor promptly so that he or she can determine the cause, which is usually serious, and initiate further treatment steps. Preventive measures such as exercise and a change in diet significantly improve the survival rate. The family doctor or internist in charge can answer in detail which measures are sensible.