Cutaneous microemboli from hydrophilic polymer after endovascular procedures.
BACKGROUND
Multiple devices and coatings assist with endovascular insertion of sheaths, catheters, and guide wires. Hydrophilic polymer coatings, a common component of endovascular surgical devices, reportedly cause microvascular obstruction and embolization, with various sequelae in organs and soft tissue.


OBJECTIVE
We sought to describe clinical and histopathologic features of cutaneous manifestations of hydrophilic polymer gel emboli.


METHODS
We evaluated the clinical and histopathologic characteristics of 8 patients with cutaneous complications of hydrophilic polymer gel emboli who presented in May 2013 through February 2015.


RESULTS
Sudden onset of lower extremity livedo racemosa, purpuric patches, or both, occurred hours to days after endovascular procedures involving the aorta. Histopathologic evaluation showed basophilic lamellated material, consistent with hydrophilic polymer gel emboli, within small dermal vessels.


CONCLUSIONS
This was a retrospective study with small sample size and not controlled for all similar procedures in this population.


CONCLUSIONS
Hydrophilic polymer gel coatings in endovascular devices can embolize to skin and cause microvascular occlusion, presenting as livedo racemosa, purpura, or both. Given the number of patients observed over a short period, this phenomenon may be underappreciated. Hydrophilic polymer gel emboli should be considered in differential diagnosis of livedo racemosa and purpura after endovascular procedure.
Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
Agnieszka K
AK
Thompson
Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
Margot S
MS
Peters
Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
Rokea A
RA
El-Azhary
Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
Lawrence E
LE
Gibson
Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
Michael B
MB
Chang
Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
John R
JR
Griffin
Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
Mark D P
MD
Davis
Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
Marian T
MT
McEvoy
Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
Michael J
MJ
Camilleri
Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota. Electronic address: bridges.alina@mayo.edu.
Alina G
AG
Bridges
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D057785:Catheters / Q000009:adverse effects; D020099:Coated Materials, Biocompatible / Q000009:adverse effects*; D004617:Embolism / Q000209:etiology* / Q000473:pathology*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012494:Sampling Studies; D012871:Skin Diseases / Q000209:etiology* / Q000473:pathology
D020099:Coated Materials, Biocompatible; D011108:Polymers
catheterization; coating; complications; emboli; endovascular procedure; hydrophilic polymer; livedo racemosa; purpura