Massive bowel infarction after percutaneous transluminal renal angioplasty.

We report the case of a patient with atherosclerotic renal artery stenosis (ARAS) who developed massive bowel infarction caused by cholesterol crystal embolization (CCE) after percutaneous transluminal renal angioplasty (PTRA). CCE is a complication of diffuse atherosclerosis, and it is responsible for a variety of complex clinical findings due to various degrees of multi-organ damage; it can range from being clinically silent to resembling other systemic diseases, such as vasculitis [1]. CCE in the vessels of the digestive tract suggests a very advanced and diffuse atherosclerosis with a serious outcome. Although CCE is a recognized complication of intra-arterial catheter manipulation, bowel infarction due to CCE after percutaneous treatment of ARAS is rare. Considering that the best treatment of atheroembolic disease is prevention, clinicians should be aware of this condition, especially in view of the increasing size of the population with atherosclerosis that undergoes invasive vascular procedures. This case may suggest the utility of an accurate evaluation of the atherosclerotic condition prior to PTRA, especially in those patients with a higher risk of CCE (elderly patients with diffuse and severe atherosclerosis or previous cardiovascular complications).