Hydrophilic Polymer Embolism: Incidence of a Recently Recognized Iatrogenic Disease in a Retrospective Autopsy-Based Study of 136 Patients
Rupal I Mehta, Rashi I Mehta, Julia M Choi, Rudy J Castellani, Allen P Burke. University of Maryland Medical Center, Baltimore, MD; State University of New York Upstate Medical University, Syracuse, NY
Background: Hydrophilic polymers are commonly applied as coating on endovascular device surfaces and have the potential to dissociate from devices during endovascular manipulation, causing hydrophilic polymer emboli (HPE). Adverse events related to this phenomenon have only recently been recognized. The incidence of this iatrogenic complication is unknown.
Design: We conducted a retrospective autopsy study at a tertiary care hospital to evaluate the incidence of hydrophilic polymer embolism (January 1, 2010-May 31, 2012). H&E-stained sections were evaluated for the presence, total number and location(s) of HPE. Localized (single organ) versus disseminated (multiple organ system and/or bilateral lung) involvement by HPE was determined. Findings were correlated with clinical data and patient outcome.
Results: During this period, 136 consecutive adult and adolescent autopsies were evaluated on 63 male and 73 female patients (age range: 10-96 years). Of these, 17 cases (13%) showed histologic evidence of HPE involving the lungs (n=17), heart (n=3), and/or central nervous system (n=2). Afflicted patients included 12 men, 5 women, and 1 teenage boy (age range: 16-73 years). There were no statistically significant differences in mean age between affected and unaffected patients (53 years versus 55 years, respectively; p=0.65). Affected patients underwent central venous catheterization (n=17), peripherally inserted central catheterization (n=3), hemodialysis (n=7), continuous veno-venous hemofiltration (n=2), cardiac catheterization (n=3), extracorporeal membrane oxygenation (n=4), and/or cardiac (n=4) or peripheral vascular (n=1) bypass. On clinicopathological correlation, localized HPE was an incidental finding in 10 patients, while diffuse HPE contributed to morbidity in 7 patients, being associated with constitutional changes, coagulopathy, ischemic events, and/or vasculitis. In patients with disseminated disease, death occurred hours to weeks after suspected embolic events. Statistically significant difference in hospital length of stay was noted between the affected and unaffected group (48 days versus 26 days, respectively; p <0.05).
Conclusions: Hydrophilic polymer embolism occurs relatively commonly in hospitalized patients. This phenomenon represents an under-recognized iatrogenic cause of morbidity and mortality and may occur more frequently in patients with extended hospital length of stay.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 8, Wednesday Morning