Treatment and prognosis

The treatment options for a patient with the cholesterol emboli syndrome are limited:

• multiple treatment regimens have been generally unsuccessful in altering the course of the disease process
  • most significant impact on the disease can be made by its prevention
  • thrombolytic and anticoagulant treatments are not indicated and only supportive care for such symptoms as hypertension, ulceration, and gangrene is advocated (1)
• amputation of affected lower limb may be necessary; an end-diastolic pneumatic boot has been used as an alternative to amputation (2)

Prognosis depends on the extent of the systemic disease and a high rate of mortality (75-80%) is recorded due to multifactorial, cardiac, and renal aetiologies

Notes:

• statins may help to stabilise atheromatous plaques
• steroids have previously been used to attempt to reduce the inflammatory component
  
  

Reference:

• Heart 2003;89:e17 (http://www.heartjnl.com/cgi/content/full/89/5/e17)
• Filip JR, Dillon RS.Treatment of end-stage "trash feet" with the end-diastolic pneumatic boot. Angiology. 2008 Apr-May;59(2):214-9.