#renalpath #vascularpathology
The microscopic photograph shown is from a patient who had a vascular procedure and presented with renal dysfunction. Cholesterol emboli were seen in the arcuate, interlobar and interlobular arteries as well as arterioles.

Bertel Thorvaldsen the famous danish sculptor of the 19th century, suddenly died. His autopsy showed numerous atheromatous plaques in anterior coronary artery one of which was ulcerated and drained the atheromatous mass into the arterial cavity.

This was possibly the first described case of atheroembolism. These emboli can travel through the blood vessels and lodge into smaller vessels in organs, resulting in end organ damage/failure.

The organs most commonly affected are kidneys, skin, gastrointestinal system, central nervous system and heart. Although rare, iatrogenic causes especially vascular procedures are responsible for most of the cases.

Vascular procedures like abdominal aortic aneurysm resection, endovascular surgery, angiography and coronary artery bypass surgery may precipitate it. Guidewires and catheters used in these procedures may scrape the arterial walls and disrupt the atherosclerotic plaques.

Histologically, cholesterol crystal emboli are identified in the lumen of small arteries as biconvex, needle-shaped, and empty clefts because they dissolve during specimen processing.