Cholesterol Crystal Embolisms Complicating Coronary Artery Bypass Surgery: One Case Report

Introduction: Cholesterol crystal emboli (CCE) affect small caliber arteries, 100 to 400?, and originate from unstable plaques usually located on the aorta and sometimes lower extremity arteries. Depending on the level of origin of the emboli, the symptomatology is highly variable, ranging from blue toes to systemic cholesterol crystal embolism disease to renal and/or digestive involvement. Observation: We report the observation of a 60 - year - old patient with multiple cardiovascular risk factors admitted for management of tritruncal coronary artery disease. The arterial doppler of the neck and lower limb vessels found diffuse atheromatous overload without significant stenosis. The patient underwent coronary artery bypass grafting under extracorporeal circulation with aortic clamping. The postoperative course was marked by the occurrence of bilateral distal ischemia of the toes with preservation of the distal pulses, the arterial doppler showed no change compared to the preoperative one. The biological blood test showed progressive renal failure with preserved dieresis. The diagnosis retained is a distal ischemia due to cholesterol embolism, which evolved into toe necrosis requiring toe amputation. Treatment with antiplatelet agents and statin was reinforced with a spectacular clinical improvement. Conclusion: We report through this observation in the light of the literature data the severity of cholesterol emboli and their therapeutic management.