The surgical management of disseminated
atheroembolism was studied in seven patients. The diagnosis of disseminated
atheroembolism from extensive degeneration of the thoracic and abdominal aorta was based on clinical evidence of cutaneous
atheroembolism, angiographic demonstration of irregular aortic plaques, and findings of
cholesterol emboli in tissue specimens. All patients had severe cardiopulmonary disease. In four cases treatment consisted of palliative axillobifemoral bypass with
ligation of the external iliac arteries to exclude the proximal aortic source of emboli to the feet. Three patients underwent intestinal resection for visceral
atheroembolism. Permanent access for
hemodialysis was required in four patients. All patients died within 6 months of the diagnosis of disseminated
atheroembolism. Surgical
therapy has three roles in disseminated
atheroembolism: prevention of further
atheroembolism with its attendant peripheral or visceral organ damage;
amputation or resection of irretrievably damaged tissue; and provision of chronic
hemodialysis access. The optimal treatment is thoracoabdominal reconstruction of the aorta. In the high-risk patient, axillobifemoral bypass with iliac
ligation may be used to treat recurrent painful
atheroembolism to the feet. Continuing
atheroembolism to the visceral and pelvic circulation, renal failure, and progressive
asthenia are associated with the poor prognosis of patients with this disease.