Cutaneous Polymer-Coating Embolism After Endovascular Procedures: Report of Two Cases and a Literature Review

Abstract

Different hydrophilic and hydrophobic polymers are used as lubricious coatings to reduce vascular traumas in minimally invasive percutaneous procedures. Although they are usually very safe, there is still a risk of serious complications in patients undergoing such procedures, mostly derived from the devices' coating detachment and systemic embolization. The lungs are the most common organ involved, followed by the central nervous system. Yet, cutaneous embolization is unusual, and only 19 cases are available in the literature. Most commonly, they present as asymptomatic retiform purpura on the lower legs, which tends to involve spontaneously. Correct clinical diagnosis is not suspected in most cases, being cholesterol emboly or vasculitis the preferred options. Time interval since surgical procedure and appearance of lesions vary widely but they generally start in the first few days. Histopathological identification of the embolus as bluish, amorphous intraluminal material in dermal vessels is diagnostic, but vasculitic signs are not present. We report 2 cases of skin lesions as the main manifestation of polymer embolization after endovascular surgical procedures. In both cases, biopsy allowed identification of embolized foreign material and lesions resolved without specific treatment.

Silicone Granulomas at the Peripheral Intravenous Cannula Puncture Site

“…Foreign body reactions to hydrophilic polymer coatings of different catheters and cannulas used in endovascular procedures are nonrefractile and commonly stain with colloidal iron and Alcian blue. 8,9 The authors believe that these features, within the proper clinical and pathologic setting, should be enough for an accurate diagnosis, as in the present case.…”

Polymer Emboli Complicating Transcatheter Aortic Valve Implantation

“…This technology has greatly contributed to the accessibility of larger-diameter catheter procedures, such as transcatheter aortic valve replacement; however, one of the drawbacks of lubricated polymer coatings is the separation of the polymer coat during an interventional procedure. 1 …”