cholesterol emboli in IABP

 Q: 58 years old male is in ICU with cardiogenic shock. Patient continues to require Intra Aortic Balloon Pump (IABP) for hemodynamic support. Which features to watch for cholesterol emboli?

Answer:

One of the undesirable consequences of IABP is cholesterol embolization. Some of the cardinal features of this complication are:

• thrombocytopenia
• livedo reticularis
• eosinophilia, and
• eosinophils in the urine sediment (signifies renal atheroemboli)

One of the most important clinical lessons in this situation is NOT to use chronic anticoagulation unless absolutely needed. This may lead to promoting further embolization. The best intervention is to remove the IABP.

#procedure

References:

1.Alderman JD, Gabliani GI, McCabe CH, et al. Incidence and management of limb ischemia with percutaneous wire-guided intraaortic balloon catheters. J Am Coll Cardiol 1987; 9:524. 

2. Hyman BT, Landas SK, Ashman RF, et al. Warfarin-related purple toes syndrome and cholesterol microembolization. Am J Med 1987; 82:1233.