Sekine Yuji, Furutake Tatsuya, Kusuhara Takayoshi, Ann Kenta, Nakatsuka Daisuke, Nonaka Michihito, Iwakura Atsushi, Yamanaka Kazuo
Department of Cardiovascular Surgery, Tenri Yorozu Hospital, Tenri, Japan.
Kyobu Geka. 2011 Mar;64(3):195-9.
A 70-year-old man underwent graft replacement for infrarenal abdominal aortic aneurysm, 50 mm in diameter. Postoperatively, he suffered from bilateral lower extremital ischemia. Although he underwent emergency embolectomy of both legs under general anesthesia, severe purplish discoloration of the distal lower extremities developed, and acute renal dysfunction occurred. He was diagnosed with cholesterol crystal embolization syndrome (CCE). We initiated intravenous steroid therapy and infused prostagrandin intraarterially and conducted low density lipoprotein (LDL) apheresis. However, his renal function did not improve and his bilateral toes became necrotic completely. Multiple organ failure rapidly worsened and he died at 38 days after surgery. CCE complicated with severe renal dysfunction is a lethal iatrogenic complication after surgery for abdominal aortic aneurysm. Because the number of CCE is likely to increase in the near future, we should study about CCE more seriously.
一名70岁男性接受了直径50毫米的肾下腹主动脉瘤移植置换术。术后，他出现双侧下肢缺血。尽管他在全身麻醉下接受了双腿紧急取栓术，但下肢远端仍出现严重的紫绀，并且发生了急性肾功能障碍。他被诊断为胆固醇结晶栓塞综合征（CCE）。我们开始进行静脉类固醇治疗，动脉内输注前列腺素，并进行低密度脂蛋白（LDL）血浆分离术。然而，他的肾功能并未改善，双侧脚趾完全坏死。多器官功能衰竭迅速恶化，他在术后38天死亡。CCE合并严重肾功能障碍是腹主动脉瘤手术后一种致命的医源性并发症。由于CCE的病例数在不久的将来可能会增加，我们应该更认真地研究CCE。
