What precautions should be taken during aortic surgery of a patient with cutaneous cholesterol emboli (CCE)?

Updated: Apr 12, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

During aortic surgery, gentle clamping, no reclamping, and minimal handling of the aorta are recommended. Smaller, less rigid catheters and less manipulation of them is important, as is the avoidance of high-pressure injectors. For aortography, consider a transaxillary approach instead of a translumbar approach if aortic plaques are present; however, the transaxillary approach is technically more difficult, with an increased risk of thrombosis, hematoma, and possible brachial plexus injury.

Avoid anticoagulants, which can cause hemorrhage within the walls of sclerotic arteries, with subsequent thrombosis and elevation of an atheromatous plaque.


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