BACKGROUND AND OBJECTIVES: Atheroembolism, caused by peripheral emboli
zation of small cholesterol crystals that fracture off of ruptured ath
erosclerotic plaques in the major vessels, leads to multifocal ischemi
c lesions and progressive tissue loss. The end result is often ischemi
c injury in the skin, kidney, brain, myocardium, and intestine, but an
y organ distal to the culprit lesion may be affected. The precise inci
dence of this serious clinical syndrome has been difficult to ascertai
n from the available literature, but it appears to be much more common
than has been assumed. The objective of the present study is to clari
fy the incidence of atheroembolism among inpatients in an acute hospit
al setting. PATIENTS AND METHODS: We surveyed inpatient nephrology con
sultations during a 7-month period from January through July 1994. Fro
m a pool of 402 consultation charts, 99 were identified with two or mo
re substantive risk factors for atheroembolism. The records of 85 of t
hese patients were available for careful review. More than 300 additio
nal patients were found to have ICD-9 discharge codes for other vascul
ar conditions, but we were unable to confirm that any of these were in
fact cases of atheroembolism, since there is no specific ICD-9 discha
rge code for this entity. In the 85 cases reviewed, a diagnosis of ath
eroembolism was made only if the patient had identifiable substantive
risk factors, suggestive physical findings, and supporting laboratory
results. RESULTS: Eleven of the 85 surveyed records documented strong
evidence supporting a ''probable'' diagnosis of atheroembolism. Tissue
was examined in 4 of these 11, resulting in definitive histologic con
firmation in 3. Another 5 of the 85 surveyed records were ''suggestive
'' of atheroembolism. Altogether, atheroembolism was a likely diagnosi
s in a total of 16 cases during this 7-month period, or 1 case every 2
weeks. These cases comprised 19% of nephrology consultations in which
2 or more risk factors were present, or 4% of all nephrology consulta
tions. The patients' records confirmed the serious implications of cli
nically detectable atheroembolism. Several patients underwent lower ex
tremity amputation, nearly half required acute or chronic dialysis, an
d more than half died within several months of diagnosis. CONCLUSIONS:
The present study suggests that at least 4% of all inpatient nephrolo
gy consultations, representing approximately 5% to 10% of the acute ve
nal failure encountered, involve clinically significant atheroembolism
. Patients with atheroembolism appear at a rate of at least 1 case eve
ry 2 weeks. They often have identifiable substantive risk factors at i
nitial consultation, and probably represent only the most severe cases
of atheroembolism. In view of the serious implications of this basica
lly untreatable syndrome, heightened awareness and preventive maneuver
s in the population at risk are essential.