H. Fujii et al., MYONEPHROPATHIC METABOLIC SYNDROME AFTER BILATERAL AORTOILIAC BYPASS - A PATHOGENIC ROLE OF CHOLESTEROL MICROEMBOLI - A CASE-REPORT, Vascular surgery, 32(5), 1998, pp. 513-517
A 72-year-old man was admitted to our hospital for management of inter
mittent claudication. A preoperative angiogram showed right common ili
ac artery occlusion with well-maintained peripheral flow via collatera
ls and 50% stenosis of the aortic bifurcation through the left common
iliac artery. The authors performed bilateral aortoiliac artery bypass
surgery. Immediately following the operation, the left lower limb was
cyanotic and cold despite a good pulse in the left dorsalis pedis art
ery. He suffered from severe pain throughout his entire left calf and
part of his thigh. Thrombolytic therapy combined with anticoagulation
therapy was started in an attempt to reduce limb ischemia. However, sw
elling of the left calf increased, and clinical and metabolic manifest
ations consistent with myonephropathic metabolic syndrome (MNMS) devel
oped. Serum creatine kinase and creatinine rose to 21,600 u/L and 2.8
mg/dl, respectively. His toe became necrotic and a transmetatarsal amp
utation was done. A skin biopsy taken from the edge of the amputation
revealed cholesterol crystals within the capillaries. This report sugg
ests that massive cholesterol microemboli are responsible for MNMS in
this patient.