A cholesterol embolism or cholesterol embolism is a serious disease that is caused by a narrowing of the arteries and inflammation. This in turn is caused by the flooding in of cholesterol crystals, which are mostly solved by surgical interventions (75%). The prognosis for cholesterol embolism is poor as it often leads to chronic kidney failure.
What is a cholesterol embolism?
According to DigoPaul, cholesterol embolism occurs when cholesterol is released, usually from atherosclerotic plaque, and flows with the bloodstream to other parts of the body.
There it sticks and narrows the blood vessels. Cholesterol embolism usually manifests itself as skin problems, gangrene (death of tissue) or kidney failure. Problems with other organs can also arise, depending on where in the body the cholesterol enters the bloodstream. The diagnosis is usually made via a biopsy (removal and analysis of tissue) of the affected organ.
A cholesterol embolism is treated by directly treating the causes and treating the accompanying symptoms. Statin drugs have shown positive results in treatment.
It is relatively uncommon for cholesterol embolism to occur suddenly (about 25% of all cases). This mainly happens in people with advanced cases of arteriosclerosis in large vessels, such as the aorta.
In the other 75%, cholesterol embolism results from complications arising from treatments on the blood vessels; e.g. angiography or vascular surgery. With a 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 are either intended to increase the coagulation of the blood or to dissolve clumps. Such a treatment then possibly leads to an increased shedding of cholesterol, which then leads to constrictions in the blood vessels elsewhere in the body.
Symptoms, ailments & signs
A variety of symptoms can occur with cholesterol embolism. However, these depend on which organs are affected. The prognosis for this disease is very poor. Acute or chronic kidney failure is common. As a further symptom, reticulate bluish-purple tinting of the skin often occurs.
It can also lead to the so-called blue-toe syndrome, which is characterized by circulatory disorders in the toes. Among other things, small bleeding occurs in the nail bed. In addition, the toes turn purple. The digestive system is also often affected. There are often severe abdominal pain caused by severe circulatory disorders in this area.
The severe pain is accompanied by nausea and vomiting. The stool may be black in color due to bleeding in the stomach or intestines. Pancreatitis often develops, which can lead to the destruction of the pancreas. When the musculoskeletal system is affected, joint and muscle pain occurs. Involvement of the nervous system often leads to confusion, impaired consciousness and sometimes even temporary blindness.
In addition, strokes or stroke- like symptoms can occur. General symptoms such as severe malaise with fever and emaciation are also very often observed. A third of the patients remain permanently dependent on dialysis. Deaths often occur from circulatory failure, infections, internal bleeding in the gastrointestinal tract, or from pancreatitis.
Diagnosing cholesterol embolism can be difficult because the symptoms of the complaint are very similar to those of others; e.g. vasculitis or kidney problems.
The cause of poor kidney values, which can be triggered by a cholesterol embolism, can also have a variety of other causes. Blood and urine tests are done in most cases. These can show the inflammation; in a blood count, in 60% of cases of a cholesterol embolism, increased levels of white blood cells can be found. The urine may contain elevated levels of red blood cells and protein.
The definitive diagnosis can only be made with the biopsy. In the tissue sample, the cholesterol crystals that are responsible for the cholesterol embolism can be identified through an analysis. In some cases, tissue examination is also not definitive, but it can rule out other diseases (such as vasculitis).
In the worst case, a cholesterol embolism can damage the organs. As a rule, patients with this disease suffer from severe weight loss, which cannot be stopped with excessive food intake. Nausea and fever also develop, and most patients also complain of loss of appetite.
The quality of life is extremely reduced by the cholesterol embolism. Various organs are also damaged. In the worst case, the kidneys can also be affected, leading to complete kidney failure. The central nervous system is also affected by the cholesterol embolism, as a result of which the patient can suffer sensitivity disorders.
A targeted treatment of the cholesterol embolism is not directly possible. Above all, the symptoms and the damage to the various organs are treated. The further spread of the disease must also be restricted. If certain organs have already been damaged, a transplant may be necessary.
In the case of renal insufficiency, the person concerned is then dependent on dialysis. Various medications are also used to counteract the symptoms. The further complications depend heavily on the damage to the respective organs. As a rule, life expectancy is reduced by the cholesterol embolism.
When should you go to the doctor?
If abdominal pain, reddening of the skin and other typical signs of a cholesterol embolism are noticed again and again, it is advisable to see a doctor. Symptoms of renal insufficiency or reduced blood flow should be clarified immediately because of the possible complications.
In any case, a medical professional must be consulted who can diagnose and treat the disease. High-risk patients in particular – such as people with advanced cases of arteriosclerosis and patients after vascular surgery or angiography – should speak to their doctor if they have unusual symptoms.
If the weight loss characteristic of cholesterol embolism causes symptoms, the responsible doctor 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 may also have to be provided. In the case of renal insufficiency, a doctor must be consulted regularly. In the event of complications, it is best to call the emergency number or go to the nearest hospital.
Treatment & Therapy
Hemodynamic control, including pulmonary artery catheterization, may be useful for improving blood flow. If acute lung failure occurs, artificial ventilation may be necessary for a longer period of time.
Dialysis may be needed if kidney function is found to be decreased. As a result, measures to support the metabolism and artificial nutrition are necessary, as those affected can quickly lose body weight and vitality due to their situation. After a cholesterol embolism, inverse treatments on the blood vessels should be avoided; 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 operations may be necessary to remove the sources of the obstructing material, and the placement of surgical stents is another method of avoiding embolism.
Damaged tissue should be protected and given time to heal; the chances of recovery are good. Dead tissue must be removed. In severe cases, a sympathetic block in the lumbar region can be used to reduce the loss of tissue in the lower body.
Outlook & forecast
The prognosis of a cholesterol embolism is classified as unfavorable. Since chronic kidney failure occurs as the disease progresses, the death rate for patients is very high. Nevertheless, the outlook is heavily dependent on the location of the vascular occlusion and other factors. More than 1/3 of all patients become permanent dialysis patients and have no prospect of a cure.
In acute cases, they are threatened with mortal danger and thus premature death. About 25% of patients die from cholesterol embolism within 2 years. Without medical care, death is much more likely. The death rate increases in patients of old age and with other diagnosed diseases.
The prospects are particularly bad for people with diabetes or heart failure. Due to the different risk patients, the treatment of cholesterol embolism is often aimed at extending the life span and at the same time reducing the progression of the disease. With a weakened immune system, the risk of infection increases, which is in addition to a poor prognosis.
The best prospects for a cure are those of young to middle adulthood, with a healthy lifestyle and no other illnesses. With timely medical treatment for cholesterol embolism, recovery can occur. These patients can also achieve better health with a donor organ and a transplant.
Preventing cholesterol embolism directly is difficult. It mostly occurs in people who already have diseases that promote embolism. According to the current status, the risk factors are: male gender, high blood pressure, smoking, coronary heart disease, renal artery stenosis, cerebrovascular disease, arterial occlusive disease.
Follow-up care for cholesterol embolism includes the period of rest and careful observation of the physical symptoms. If there are any skin changes or evidence of kidney failure, patients must contact their doctor immediately. Depending on the cause of the disease, the triggers may be combated as part of 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 alleviate the symptoms. Diet is also recommended in many cases. As a result, the further prognosis for the patient looks much more positive. In addition to changing your diet, the doctor recommends more physical activity to prevent a possible relapse. Follow-up care here is similar to prophylaxis.
Depending on the severity of the disease, additional steps can be taken as part of the follow-up treatment. In close consultation with the attending physician, patients learn more about the possibility of improving their quality of life. Good self-observation helps to identify possible risks early on. Consistent follow-up care helps to reduce the risk of the disease and improve the quality of life.
You can do that yourself
If a cholesterol embolism is suspected, the attending physician must first be informed. Self-help measures should be avoided, as the condition can only be treated with medication. Accordingly, the most important accompanying measure is to take it easy and inform the doctor of any unusual symptoms. For example, if there are changes in the skin or signs of kidney failure, the doctor must be informed immediately.
In addition, the cause of the cholesterol embolism must be found. The medical diagnosis is supported by noting any triggers. So diet should also be considered as a cause, such as previous illnesses or genetic predispositions. After the diagnosis has been made, the doctor can prescribe a drug from the substance class of statins and thereby relieve the suffering.
Early diagnosis is crucial for a positive outcome. Patients must speak to the doctor as soon as possible so that he can determine the mostly serious cause and initiate further treatment steps. Preventive measures like exercise and changing your diet will greatly improve survival rates. The responsible family doctor or internist can answer the detailed measures that make sense.