DermatopathologyCutaneous microemboli from hydrophilic polymer after endovascular procedures
Section snippets
Methods
We performed retrospective analysis of 8 patients identified between May 2013 and February 2015 at Mayo Clinic's campus in Rochester, MN. Our institutional review board waived the need for formal approval of this case series. Hematoxylin-eosin–stained sections of punch biopsy specimens obtained from the purpuric lesions during the course of patient care (Fig 1) were reviewed. X-ray probe microanalysis was performed on 1 specimen (patient 6) and colloidal iron staining on biopsy specimen from 2
Results
The clinical features, endovascular procedures, and clinical course of each patient are summarized in Table I. Patient age ranged from 58 to 81 years; 7 of the 8 patients were men. All patients had multiple medical comorbidities, and 5 patients had previous endovascular procedures, including aortic graft repair, endarterectomy, and coronary bypass. Patients 2 and 4 underwent repair of the thoracic aorta in addition to repair of the aortic valve. Patient 6 had only aortic valve insertion.
Discussion
Endovascular procedures enable temporary insertion of catheters and sheaths, and permanent placement of grafts and stents.1 The benefits of hydrophilic polymer coatings include decreased coefficient of friction; improved maneuverability in the vascular space, particularly in tortuous vasculature; prevention of vasospasm; and decreased thrombogenicity.1, 6, 7 However, the introduction of this foreign material into the vasculature brings risk of the clinical consequences of embolization.
In vitro
References (12)
- et al.
Hydrophilic polymer emboli: an under-recognized iatrogenic cause of ischemia and infarct
Mod Pathol
(2010) - et al.
In vivo distribution of particulate matter from coated angioplasty balloon catheters
Biomaterials
(2013) - et al.
Polymer embolization from minimally invasive interventions
Am J Kidney Dis
(2013) - et al.
Autopsy demonstration of intramyocardial polymer gel emboli associated with a giant-cell reaction following cardiac catheterization: a case report
Cardiovasc Pathol
(2012) - et al.
Intravascular polymer material after coil embolization of a giant cerebral aneurysm
Hum Pathol
(2009) - et al.
Complications of endovascular polymers associated with vascular introducer sheaths and metallic coils in 3 patients, with literature review
Am J Surg Pathol
(2008)
Cited by (32)
Thrombotic vasculopathy due to polymer coating emboli after an endovascular procedure
2021, JAAD Case ReportsCitation Excerpt :The clinical presentation most classically involves sudden onset of nonpalpable, purpuric macules and patches, livedo reticularis, and painful nonhealing ulcers or nodules.3 The lesions are most often distributed on the lower extremities.3,7 Cutaneous manifestations of polymer coating emboli may occur within hours up to nine days following an intravascular procedure.3
Necrotic leg ulcers secondary to hydrophilic polymer gel emboli
2019, Journal of Vascular Surgery Cases and Innovative TechniquesCitation Excerpt :The FDA is developing testing strategies to evaluate coating performance and to improve device standards.2 Polymer coating emboli in the dermal vasculature can appear clinically as nonpalpable petechiae and purpura, reticulate purpura, acute and chronic ulcerations, hyperkeratotic and lichenified nodules, and hemorrhagic panniculitis.3,5,7-9,19 Similar findings can also be seen in conditions such as vasculitis, venous stasis ulcers, cholesterol emboli, and calciphylaxis.
Cutaneous foreign body granulomas following cervico-facial arterial embolization: Three cases
2018, Annales de Dermatologie et de VenereologiePolymer coating embolism from intravascular medical devices — a clinical literature review
2017, Cardiovascular PathologyCitation Excerpt :It should be noted that other devices used during either procedure are not listed and may have also contributed to the varied appearance of coating compositions. Polymer coating embolism has been affiliated with a range of adverse clinical sequelae [12–37,39]. Dominant reported conditions include occlusions of small and medium-sized vessels within the brain [12,15,16,22,34], heart [17–19,21,24], lungs [14,16,29,32], and skin [16,25–27,30], often associated with ischemia, infarct [12,15,16,24,29,32,33,34,39], or hemorrhage [12,22,25,27,30,32,34] and surrounded by intravascular inflammatory response (granulomas or giant cell reactions) [12,14–18,21,24,26,27,29–34].
Hydrophilic Polymer Embolism: An Update for Physicians
2017, American Journal of Medicine
Dr Griffin is now with Departments of Internal Medicine and of Laboratory Medicine and Pathology, Texas A&M University Health Science Center, Dallas.
Funding sources: None.
Conflicts of interest: None declared.