CathLabHub

CathLabHub complications toolkitcathlabhub.com/toolkit/atheroembolismIn review, October 24, 2026

Recognize

The signs on the monitor, the image and the patient.

  • PatientLeg or foot pain, livedo reticularis and intact pulses: the classic triad 1.
  • PatientBlue or purple toes, digital gangrene 2.
  • LabEosinophilia and rising creatinine, often days to weeks later 12.
  • PatientRetinal, gut or brain involvement in widespread embolization.
  • LabIncidence 1.4 percent in a prospective study after cardiac catheterization 3.

Act now

In the order the operator does them. The first three come first, whatever else is happening.

  1. Recognize it and stop further aortic instrumentation where possible.
  2. Supportive care for the kidney, the skin and the limb 1.
  3. Statins may help the kidney injury 1.
  4. Pain control and wound care for the toes.
  5. Nephrology for renal failure; dialysis when needed.
  6. Sources differ: Kern reports in hospital mortality up to 16 percent in definite cholesterol embolization syndrome; outcomes vary with the extent 2.

Equipment

From the complications cart. Linked items open in the equipment directory.

Drugs

Adult doses as the cited source gives them. Check your formulary and the label.

  • StatinMay help the kidney injury 1.

Who to call

The escalation ladder, first call first.

  1. Nephrology: for the kidney.
  2. Vascular surgery or wound care: for digital ischemia.
  3. Dermatology: if the diagnosis needs a skin biopsy.

The bailout step by step

Catheter technique that lowers the embolic load 2

  1. Lead every catheter with a wire through the aorta 2.
  2. Aspirate blood from the catheter after it reaches the root and discard it before injecting 2.
  3. Clear the Y connector before advancing through it 2.
  4. Use the fewest catheter exchanges and the smallest catheters that will do.
  5. Choose the access that avoids the most diseased aorta.

Prevent

  • Wire led catheter advancement and aspiration of debris 2.
  • Radial access in a diseased abdominal aorta.
  • Fewer exchanges in a shaggy aorta.

After care and documentation

  • Follow creatinine and skin findings for weeks.
  • Document the findings and the eosinophil count.

Practice

No emergency simulator case for atheroembolism. Browse the case library.

References

  1. Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 29, Vascular access complications.
  2. Berg R, Lim MJ. Complications of percutaneous coronary interventions. In: Kern MJ, ed. The Interventional Cardiac Catheterization Handbook. 3rd ed. Saunders, Elsevier; 2013. Chapter 4.
  3. Fukumoto Y, Tsutsui H, Tsuchihashi M, et al. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol 2003;42:211-216.

Educational reference for cath lab teams, not medical advice and not a standard of care. Your local policy, the device instructions for use and current guidelines govern. Verify every dose before use. Printed from cathlabhub.com/toolkit/atheroembolism. First version, in clinical review: an interventional cardiologist is checking every card before it is final. Every number cites its source on the card.