title: Hydrophilic polymer embolism and associated vasculopathy of the lung: prevalence in a retrospective autopsy study.
abstract: Hydrophilic polymers are commonly applied as surface coatings on vascular devices and have been shown to dissociate during endovascular use, causing hydrophilic polymer embolism (HPE). Adverse effects related to this phenomenon have been recognized and reported. The prevalence of this complication is unknown. We conducted a retrospective study to determine the prevalence of HPE among hospital autopsies over a 29-month period. Postmortem tissue was histologically evaluated for the presence, location(s) and extent of HPE. HPE findings were correlated with documented clinical and laboratory data and patient outcome. Of 136 hospital autopsies examined, 18 (13%) showed evidence of HPE involving the lungs (n = 18), heart (n = 1) or central nervous system (n = 1). Localized pulmonary HPE was seen in 12 patients (9%). Multifocal pulmonary HPE was found in 6 patients (4%) and was associated with clinical vasculitis (33%; P < .0001), suspected pulmonary ischemia (50%; P = .008), coagulopathy (67%; P = .002), and constitutional disease (83%; P = .01). Within affected lung, associated histopathologic changes included occlusive intravascular or perivascular inflammation (89%), intravascular fibrous response (56%), microthrombus formation (44%), vasculitis (28%), and/or pulmonary microinfarction (28%). Statistically significant differences in hospital days (P = .008) and number of vascular interventions (P = .01) were noted between affected and unaffected patients. We conclude that HPE is an underdiagnosed phenomenon with primary involvement of the lungs, where secondary vascular changes are common. Additional studies may be needed to clarify risks and to identify preventative strategies for this iatrogenic complication of catheterizations and "minimally invasive" endovascular techniques.
authors.affiliation: University of Maryland Medical Center, Department of Pathology, Baltimore, MD, 21201. Electronic address: rmehta@som.umaryland.edu.
authors.forename: Rupal I
authors.initials: RI
authors.lastname: Mehta
authors.affiliation: State University of New York Upstate Medical University, Department of Radiology, Syracuse, NY, 13210.
authors.forename: Rashi I
authors.initials: RI
authors.lastname: Mehta
authors.affiliation: University of Maryland Medical Center, Department of Pathology, Baltimore, MD, 21201.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Choi
authors.affiliation: C-Link Micro Imaging, Inc, Los Angeles, CA, 90064.
authors.forename: Arnob
authors.initials: A
authors.lastname: Mukherjee
authors.affiliation: University of Maryland Medical Center, Department of Pathology, Baltimore, MD, 21201.
authors.forename: Rudy J
authors.initials: RJ
authors.lastname: Castellani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000379:methods; D002648:Child; D004617:Embolism / Q000453:epidemiology*; D005260:Female; D006801:Humans; D057927:Hydrophobic and Hydrophilic Interactions; D008168:Lung / Q000098:blood supply* / Q000473:pathology; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000009:adverse effects*; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D011108:Polymers
keywords: Catheterization; Drug delivery vehicle; Endovascular procedure; HPE; Hydrophilic polymer embolism; Iatrogenic complication; Vasculopathy