A Case of Cholesterol Crystal Embolism after Coronary Artery Bypass Grafting

(Department of Cardiovascular Surgery, Yamagata Saisei Hospital, Yamagata, Japan)

Yoko Sotoda Shigeki Hirooka
Hiroyuki Orita
We report a case of cholesterol crystal embolism (CCE) after coronary bypass surgery. A 65-year-old man with unstable angina and abdominal aortic aneurysm (AAA) underwent coronary artery bypass grafting (CABG). Coronary angiography (CAG) was performed at 30 days after surgery. Two weeks after the CAG, plantar cyanosis of both feet was observed and a renal dysfunction developed. A skin biopsy of the cyanotic lesion demonstrated characteristic cholesterol clefts in small submucosal arteries. Methylprednisolone (MPSL) and prostaglandin E1 (PGE1) were given for 3 days and 2 weeks, respectively. The patient's condition improved remarkably. Two months after the CAG, resection of AAA was performed and the postoperative course was uneventful. Diagnosis of CCE is difficult and its prognosis still remains poor. Therefore, we should keep this unusual complication in mind
@Jpn. J. Cardiovasc. Surg. 35: 354-357 (2006)