Fukuda H, Tsuji M, Mori H, Hirota Y, Kawamura K
2nd Department of Pathology, Osaka Medical College.
Kokyu To Junkan. 1991 Feb;39(2):193-6.
A 59-year-old man with a 10-year history of hypertension was admitted to the Osaka Medical College Hospital because of left shoulder pain, lower blood pressure in left arm, and nasal lower quadrant defect of the visual field of the left eye. After admission, he underwent coronary angiography and aortography. The examinations revealed that, although coronary arteries were normal, the orifice of the left subclavian artery was occluded almost completely. Two weeks after the examination, he underwent intra arterial DSA of the cerebral artery. After manipulation of the DSA, the patient complained of severe calf pain, developed blue toe and progressive renal failure with severe proteinuria. He died of uremia about three months after the DSA. Autopsy revealed multiple cholesterol emboli in small arteries in the visceral organs, urogenital organs and thyroid gland. In the kidneys, especially, damage by cholesterol emboli was large with irregular cortical necrosis. Examination of the brain was not permitted. This case shows that cholesterol embolism of the kidneys can be a lethal complication of angiography.
一名有10年高血压病史的59岁男性因左肩疼痛、左臂血压降低以及左眼视野鼻下象限缺损入住大阪医科大学医院。入院后，他接受了冠状动脉造影和主动脉造影。检查显示，虽然冠状动脉正常，但左锁骨下动脉开口几乎完全闭塞。检查两周后，他接受了脑动脉动脉内数字减影血管造影（DSA）。在进行DSA操作后，患者抱怨小腿剧痛，出现蓝趾，并伴有严重蛋白尿的进行性肾衰竭。DSA后约三个月，他死于尿毒症。尸检显示在内脏器官、泌尿生殖器官和甲状腺的小动脉中有多个胆固醇栓子。特别是在肾脏，胆固醇栓子造成的损害很大，伴有不规则的皮质坏死。未对脑部进行检查。该病例表明，肾脏胆固醇栓塞可能是血管造影的致命并发症。
