1/10. Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty: a report of 2 cases and review of the literature.Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty (PTCA) constitutes a distinct clinical and histopathologic entity. Pseudoaneurysms are a potential complication of both cardiac catheterization and PTCA. Repeated or prolonged catheterization increases the risk of bacterial seeding of these sites, resulting in septic embolization. Characteristic clinical features include fever within 2 to 5 days, unilateral embolic disease, and staphylococcus aureus septicemia. culture and examination of biopsy specimens of the embolic lesions typically demonstrate gram-positive microorganisms. We describe 2 patients presenting with ipsilateral palpable purpura, petechiae, and livedo reticularis caused by septic emboli from infected pseudoaneurysms. The recommended treatment includes administration of appropriate systemic antibiotics and surgical resection of the infected pseudoaneurysm. Both cholesterol and septic emboli should be considered in the differential diagnosis of ipsilateral embolic disease induced by invasive vascular procedures.- - - - - - - - - - ranking = 1keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
2/10. cholesterol emboli syndrome.The cholesterol emboli syndrome is a disorder caused by showers of microemboli which impact the small arteries. It can occur spontaneously or be precipitated by vascular surgery, arteriography or anticoagulation. The typical patient is a man older than 60 years with risk factors for atherosclerotic disease. The organs most often affected are the kidneys, skin, muscles and abdominal viscera. Common clinical presentations include renal failure and livedo reticularis or gangrene of the toes with intact pulses. eosinophilia and hypocomplementemia may occur. The syndrome can be fatal or result in end-stage renal disease, but partial recovery can also occur.- - - - - - - - - - ranking = 1keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
3/10. Renal failure following radiologic procedures.Radiologic procedures that employ intravascular contrast material with or without angiography may lead to renal failure. In procedures that use intravenous contrast alone, the mechanism of renal injury is not precisely known, but direct toxicity to renal tubular cells is likely to be a major factor. Ionic and nonionic contrast agents are both capable of causing this adverse reaction. Renal failure occurring during angiography may also be secondary to the effects of radiocontrast, but the additional possibility that micro cholesterol emboli have been dislodged from atheroma located on the intima of large vessels must be considered. The acute or subacute development of renal failure in the presence of skin changes (livido reticularis), hypertension, multiple organ failure or dysfunction, and a fatal outcome favors the later diagnosis.- - - - - - - - - - ranking = 0.24735192480444keywords = reticularis (Clic here for more details about this article) |
4/10. Multiple cholesterol emboli syndrome. Bowel infarction after retrograde angiography.The two patients described in this article are among the first to have been diagnosed with extensive bowel infarction as a result of cholesterol embolization following cardiac catheterization. The presence of acute hypertension, renal insufficiency, livedo reticularis, and gangrenous skin changes are characteristic manifestations of the multiple cholesterol emboli syndrome. Additionally, gastrointestinal symptoms and melena may herald ischemia and infarction of the alimentary tract. Anticoagulation and thrombolytic therapy are relatively contraindicated in this syndrome and may, in fact, be a precipitating cause. The prognosis is usually poor; however, survival is possible with aggressive medical and surgical therapy, despite extensive infarction of the gastrointestinal tract and other organs. Prevention remains the most critical aspect of management of this potentially catastrophic illness.- - - - - - - - - - ranking = 1keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
5/10. cholesterol embolisation: a lethal complication of vascular catheterisation.cholesterol embolisation after vascular catheterisation occurred in 5 patients. It tended to be associated with difficult manipulation of the catheter within a severely diseased aorta, and a common feature is leg pain with livedo reticularis despite palpable pulses. confusion, renal failure, and death ultimately ensue.- - - - - - - - - - ranking = 1keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
6/10. Blue digit syndrome: treatment with percutaneous transluminal angioplasty.Ten patients with classical blue digit syndrome were treated with percutaneous transluminal angioplasty (PTA). None experienced embolization. Nine were clinically improved; in eight, microembolization did not recur during follow-up of 7-86 months (mean, 28 months). Three clinical and three angiographic features were common to these eight patients: (a) few clinical episodes of microembolization; (b) no episodes of macroembolization; (c) no livedo reticularis in the affected extremity, and no symptoms of systemic cholesterol embolization; (d) focal, high-grade (greater than 90%) stenoses that were hemodynamically significant; (e) no diffuse atheromas in the aorta; (f) patent tibial runoff arteries. Affected patients with these clinical and angiographic characteristics make up a subgroup, previously unrecognized, to the authors' knowledge, in whom PTA followed by antiplatelet therapy should be the initial treatment of choice. The blue digit syndrome in these patients was probably due to microemboli composed of fibrinoplatelet aggregates rather than cholesterol debris.- - - - - - - - - - ranking = 1keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
7/10. The cutaneous manifestations of cholesterol crystal embolization.In an effort to provide a greater understanding of the cutaneous features of cholesterol crystal embolization (CCE), we reviewed the clinical features of all histologically proved cases reported in the English-language literature, exclusive of cases in which there was only central nervous system or cardiac involvement. We found that the skin is involved in 35% of patients with CCE. livedo reticularis is the most common skin manifestation (49%), followed by gangrene (35%), cyanosis (28%), ulceration (17%), nodules (10%), and purpura (9%). cholesterol crystal embolization was most common in older men and was frequently associated with anticoagulant therapy (36%) or vascular procedures (31%). Because of its protean systemic manifestations, CCE was often mistaken for vasculitis (16%) and periarteritis nodosa (12%). mortality was very high (72%). Histologic confirmation of cutaneous CCE was possible in 92% of cases where a skin biopsy specimen was obtained. We conclude that the diagnosis of cutaneous CCE should be suggested and easily confirmed histologically in the appropriate clinical setting.- - - - - - - - - - ranking = 0.24735192480444keywords = reticularis (Clic here for more details about this article) |
8/10. Cutaneous crystal cholesterol emboli.One case of cutaneous cholesterol emboli is described. In patients affected with severe arteriosclerosis of the abdominal aorta, cholesterol crystals may become detached from an atheromatous plaque and result in micro emboli ensuing skin lesions (livedo reticularis, nodules, purple toes, ulcerations, distal gangrene) on the lower extremities. Histopathologic study is required for diagnosis: the lumens of the arterioles were extensively occluded by macrophagic granuloma which surrounded cholesterol crystals.- - - - - - - - - - ranking = 1keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
9/10. Multiple cholesterol emboli syndrome after angiography.Multiple cholesterol emboli syndrome (MCES) after angiography has been reported infrequently. Seven patients (from five reports) who developed MCES after angiography are reviewed. An eighth case is described. All patients had evidence of extensive atherosclerosis. Following angiography of the eight patients, six demonstrated livedo reticularis below the umbilicus; technical difficulties were reported in four; four became febrile and/or hypertensive; and only one survived. Since therapy has been unsuccessful, careful angiographic technique is essential to prevent this syndrome.- - - - - - - - - - ranking = 1keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
10/10. Unilateral emboli in a patient with thrombotic thrombocytopenic purpura.Thrombotic thrombocytopenic purpura is a rare disease most commonly associated with microangiopathic hemolytic anemia, thrombocytopenia, fever, neurologic disorders, and renal dysfunction. We describe a patient with a history of thrombotic thrombocytopenic purpura that had been quiescent for 4 months; he had a 3-week history of painful purpuric lesions on the left hand only. He also had mottling and a livedoid purpura of the distal fingertips, splinter hemorrhages of the left fingernails, and a decreased radial pulse. Findings of a biopsy specimen revealed multiple capillary and small vessel thromboses. Contrast aortography demonstrated a pseudoaneurysm of the proximal descending thoracic aorta with stenosis of the left subclavian artery at its origin and an associated thrombus.- - - - - - - - - - ranking = 0.056803628316646keywords = livedo (Clic here for more details about this article) |
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