Embolia colesterínica en miembro superior izquierdo asociado a fístula arteriovenosa / Cholesterol embolism in the left upper limb associated with venous artery fistula

RESUMEN El embolismo por cristales de colesterol (ECC) es una complicación de la enfermedad arterioesclerótica en la que el desprendimiento de fragmentos de placa de ateroma, principalmente de grandes arterias, provoca oclusión de pequeños vasos. Esta entidad, también llamada ateroembolia o síndrome de los dedos del pie azules, es más frecuente en pacientes de edad avanzada y después de procedimientos invasivos intravasculares. Se manifiesta con cianosis, livedo reticularis, necrosis y úlceras asociado a manifestaciones renales y gastrointestinales. Se presenta un paciente trasplantado renal y portador de fístula arteriovenosa trombosada izquierda con ateroembolia localizada en mano homolateral.

ABSTRACT The cholesterol crystal embolism (ECC) is a complication of arteriosclerotic disease in which the detachment of fragments of atheromatous plaque mainly from large arteries, causes occlusion of small vessels. This entity, also called atheroembolism or blue toe syndrome, is more common in elderly patients and after intravascular invasive procedures. It manifests with cyanosis, livedo reticularis, necrosis and ulcers associated with renal and gastrointestinal manifestations. We present a renal transplant patient with a left thrombosed arteriovenous fistula with atheroembolism located in homolateral hand.

Cholesterol crystal embolism to the gastrointestinal tract: a catastrophic case

Cholesterol crystal embolism is a rare and easily overlooked cause of colonic ischemia. The gastrointestinal tract is the third most common organ system affected by cholesterol emboli, second only to kidney and skin. Here we present a catastrophic case of gastrointestinal cholesterol crystal embolism leading to extensive post-operative bowel infarction and ultimately death. For a practicing pathologist, careful attention to the vessels of any ischemic bowel and recognition of the subtle but distinct angular imprint of cholesterol crystals facilitates prompt identification of the atheroemboli. In some cases, early identification may help mitigate further tissue damage. In more acute and severe cases, identification of the cholesterol crystal emboli may be important primarily for documentation of procedural complications.

Renal Cholesterol Embolism during Warfarin Treatment

Cholesterol embolization syndrome (CES) usually occurs after endovascular procedures, it may also occurs after using anticoagulants and thrombolytics. We report a case of 66-year-old man with sudden elevation of creatinine after using warfarin due to cortical infarction. Histologic examinations revealed a cholesterol cleft on the arcuate artery. We concluded it as warfarin induced atheroembolic renal disease. Careful observation of kidneys is necessary in the case of renal abnormalities after using anticoagulation, considering the possibility of cholesterol embolism due to anticoagulant therapy.

Síndrome de embolia grasa con predominio de síntomas neurológicos / Fat embolism syndrome with predominant neurological symptoms / Síndrome de embolia gordurosa com predomínio de sintomas neurológicos

Introducción. La embolia grasa es la obstrucción de los vasos sanguíneos de pequeño calibre por lípidos producidos durante la degradación tisular. Se presenta en individuos con fracturas de huesos largos, y es asintomático en más del 90 % de los casos. El síndrome de embolia grasa corresponde a un proceso grave poco frecuente en la práctica clínica, caracterizado por la aparición de petequias, dificultad respiratoria y alteraciones neurológicas. Reporte de caso. Se trata de una mujer adulta joven con trauma cerrado de tórax y fracturas múltiples de huesos largos de las extremidades superiores e inferiores por politraumatismo de alta energía, que fue sometida a reducción bajo anestesia de las fracturas. A las 48 horas, comenzó a presentar dificultad respiratoria, exantema petequial de predominio en la pared anterior del tórax y deterioro neurológico con convulsiones tónico-clónicas focales y bilaterales, que cedieron con un medicamento anticonvulsivo intravenoso. Se le diagnosticó síndrome de embolia grasa debido al antecedente de trauma y a las lesiones evidenciadas en la resonancia magnética. Se le brindó soporte respiratorio y terapia anticoagulante, con lo cual el cuadro clínico mejoró. Discusión. El tejido graso ingresa a la circulación cuando la presión en el lecho del drenaje venoso es superada por la presión en la médula ósea. Los ácidos grasos libres tóxicos causan edema vasogénico y citotóxico, así como hemorragia por destrucción celular. Conclusión. Es importante considerar la presencia de esta complicación en pacientes con múltiples fracturas y brindar un tratamiento oportuno con la intención de disminuir las secuelas asociadas con esta condición

Introduction: Fatty embolism is the obstruction of small blood vessels by lipid product of tissue degradation. It occurs in individuals with long bone fractures, being asymptomatic in more than 90% of cases. The fat embolism syndrome corresponds to a severe and rare process in clinical practice, characterized by the appearance of petechiae, respiratory stress and neurological disorders. Case report: Young adult with high energy-polytrauma and closed chest trauma with multiple fractures of long bones of the upper and lower extremities who was taken to operating theater for redu-cing them under anesthesia. Forty-eight hours after, she began to present with respiratory distress, petechial rash predominantly in the anterior thorax and neurological deterioration with focal seizure activity to bilateral tonic-clonic, which yielded with intravenous anticonvulsant. A fat embolism syndrome was diagnosed due to the history of trauma and the lesions evidenced in the magnetic resonance. She was given respiratory support and anticoagulant therapy, with which the clinical picture improved. Discussion: The fatty tissue enters the circulation when the venous drainage bed pressure is overcome by the pressure inside the bone marrow. The toxic free fatty acids cause vasogenic and cytotoxic edema, as well as hemorrhage by cell destruction. Conclusion: It is important to consider the presence of this complication in patients with multiple fractures and to offer timely treatment with the intention of reducing the sequelae associated with this condition.

Introdução. Embolia gordurosa é a obstrução dos vasos sanguíneos de diâmetro reduzido pelos lipídios produzidos durante a degradação tecidual. Ocorre em indivíduos com fraturas de ossos longos e é assintomática em mais de 90% dos casos. A síndrome da embolia gordurosa corresponde a um processo grave, pouco frequente na prática clínica, caracterizado pelo aparecimento de petéquias, dificuldade respiratória e alterações neurológicas. Relato de caso. Trata-se de uma mulher adulta jovem, com trauma de tórax fechado e múltiplas fraturas de ossos longos dos membros superiores e inferiores por politraumatismos de alta energia, que foi submetida a redução sob anestesia. Às 48 horas, ela começou a ter dificuldade em respirar, exantema petequial predominantemente sobre a parede torácica anterior e dano neurológico com convulsões tónico-clónicas e bilateral focal, que cedeu com uma medicação anticonvulsivante intra-venosa. Ela foi diagnosticada com síndrome de embolia gordurosa devido a uma história de trauma e às lesões evidenciadas na ressonância magnética. Ela recebeu suporte respiratório e terapia anticoa-gulante, com o qual o quadro clínico melhorou. Discussão. O tecido adiposo entra na circulação quando a pressão no leito da drenagem venosa é superada pela pressão na medula óssea. Os ácidos graxos livres tóxicos causam edema vasogênico e citotóxico, além de hemorragia por destruição celular. Conclusão. É importante considerar a presença dessa complicação em pacientes com múltiplas fraturas e fornecer tratamento oportuno com a intenção de reduzir as sequelas associadas a essa condição

Síndrome del dedo azul secundario a ateroembolia por colesterol: reporte de un caso y revisión de la literatura / Síndrome do dedo azul secundário a ateroembolia por colesterol: reporte de um caso e revisão da literatura / Blue toe syndrome secondary to cholesterol atheroembolia: Report of a case and literature review

Se describe el caso de una mujer de 68 años, con muy alto riesgo cardiovascular, quien consultó por cianosis en los dedos de los pies, asociada a síntomas neurológicos focales transitorios de 5 días de evolución. Se hospitalizó con la impresión diagnóstica de síndrome del dedo azul e isquemia crítica arterial de miembros inferiores de posible origen embólico. Luego de un procedimiento endovascular, presentó deterioro neurológico súbito y se documentaron múltiples infartos cerebrales y falla renal aguda. En la biopsia de los dedos afectados se observaron cristales de colesterol en el interior de los vasos sanguíneos. Con base en el caso se presenta una corta revisión del síndrome del dedo azul y su principal causa: la ateroembolia...

We describe the case of a 68 year-old woman with very high cardiovascular risk. She consulted because of cyanosis in the toes, associated with transient focal neurological symptoms. Evolutionhad been 5 days. She was hospitalized with the diagnostic impression of blue toe síndrome and critical arterial ischemia of the lower limbs possibly due to embolic events. After an endovascular procedure, she developed sudden neurological impairment due to multiple strokes, as well as acute renal failure. Biopsy of the affected toes revealed cholesterol crystals inside the blood vessels. Based on the case, a short review about the blue toe syndrome and its main cause, atheroembolism, is presented...

Se descreve o caso de uma mulher de 68 anos, com alto risco cardiovascular, quem consulto por cianose nos dedos dos pés, associada a síntomas neurológicos focais transitórios de 5 dias de evolução. Se hospitalizou com a impressão diagnóstica de síndrome do dedo azul e isquemia crítica arterial de membros inferiores de possível origem embólico. Logo de um procedimento endovascular, presentou deterioro neurológico súbito e se documentaram múltiplos infartos cerebrais e falha renal aguda. Na biopsia dos dedos afetados se observaram cristais de colesterol o interior dos vasos sanguíneos. Com base no caso se apresenta uma curta revisão da síndrome do dedo azul e sua principal causa: a ateroembolia...

A Study of Relationship of Atheroembolic Risk Factors with Postoperative Recovery in Renal Function after Partial Nephrectomy in Patients Staged T1-2 Renal Cell Carcinoma during Median 4-Year Follow-up / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The objective of this study is to evaluate the relationship of atheroembolic risk factors with postoperative recovery of renal function after on-clamp partial nephrectomy (PN) with warm ischemia in patients with staged T1-2 renal cell carcinoma (RCC). MATERIALS AND METHODS: A total of 234 patients from 2004 to 2012 were included, and their clinicopathologic and operative parameters, including atheroembolic risk factors were reviewed retrospectively. Renal function, as determined by estimated glomerular filtration rate (eGFR) and measurement of serum creatinine level (Cr) at each scheduled follow-up for a median four years, was compared between the high-risk (HR) group (n=49, > or = five risk factors) and the low-risk (LR) group (n=185, < five risk factors). RESULTS: Except for baseline renal function and number of risk factors for atheroembolism, differences in characteristics between groups were comparatively insignificant. At 3 months after the operation, Cr and eGFR differed significantly between the two groups (p < 0.05), but no differences were observed afterward. Significant deterioration from baseline in Cr and eGFR was observed in both groups at 1 month after the operation, with a greater change in the HR group (p < 0.05). From measurement to measurement, significantly faster deterioration in Cr and eGFR was observed in the HR group than in the LR group until 6 months after the operation (Cr: LR, 0.02 mg/dL and HR, 0.13 mg/dL; eGFR: LR, 1.50 mL/min/1.73 m2 and HR, 6.38 mL/min/1.73 m2; p < 0.05). CONCLUSION: The presence of atheroembolic risk factors may negatively influence postoperative recovery of renal function after PN in patients with localized RCC.

Blue Toe Syndrome after Percutaneous Coronary Intervention / 대한피부과학회지

Blue toe syndrome involves blue or purplish toes in the absence of trauma, serious cold exposure, or disorders causing general cyanosis. Clinical presentation can range from a cyanotic toe to a diffuse, multi-organ systemic disease. A 75-year-old man presented with claudication, sudden bilateral painful discoloration of the sole, blue-colored toes, and anuria. Three weeks earlier, he had been diagnosed with acute myocardial infarction and had undergone catheterization for percutaneous coronary intervention. Histopathologic findings showed vascular ectasia with mild perivascular inflammation. Based on patient history, physical examination, and laboratory findings, he was diagnosed with blue toe syndrome. Our patient presented with clinical manifestations, including peripheral cutaneous involvement and acute deterioration of renal function. This case highlights the importance of prompt diagnosis of blue toe syndrome by careful history-taking and physical examination in order to avoid multi-organ systemic disease.

Blue toe syndrome treated with sympathectomy in a patient with acute renal failure caused by cholesterol embolization

Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE), which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.

A Case of Cholesterol Crystal Embolization presenting as Focal Myositis and Foot Necrosis / 대한내과학회지

Cholesterol crystal embolism caused by showers of cholesterol emboli from an atherosclerotic aorta is a multisystem disorder that affects many organs. Common signs and symptoms on presentation include skin findings and renal failure. However, myositis due to a cholesterol embolism is uncommon. We report a rare case of cholesterol crystal embolism that presented with features of focal and foot necrosis in an 83-year-old woman.

Nuevo enfoque para el tratamiento de las causas de ateroembolia / New approach in the treatment of the causes of ateroembolism

La ateroembolia es una entidad poco conocida y cuyo pronóstico es sombrío, especialmente en aquellos cuadros de ateroembolia diseminada, pero también en casos de ateroembolia distal que provoca un síndrome inflamatorio de respuesta sistémica. Durante 14 años recopilamos 31 casos de ateroembolia, 5 de ellas postoperatorias y 26 casos con orígenes distintos: 20 debido a aorta Shaggy y 6 a otras causas. De las 20 con aorta Shaggy, 10 presentaban ateroembolia. 22 de los 26 casos no iatrogénicos fueron tratados por vía endovascular, con una mortalidad del 9%. De acuerdo a nuestras observaciones, comentamos nuestra conducta y las variaciones en el tratamiento, proponiendo una clasificación que contemple los casos asintomáticos para el tratamiento precoz de estas lesiones aórticas, antes de producir complicaciones severas por ateroembolias o síndromes isquémicos de los miembros inferiores. Asimismo, comentamos aquellos trucos que aprendimos con la observación de los distintos casos reseñados.

A ateroembolia é uma entidade pouco conhecida e cujo prognóstico é sombrio, especialmente em quadros de ateroembolia disseminada, mas que também ocorre em casos de ateroembolia distal, o que provoca uma síndrome inflamatória de resposta sistêmica. Durante 14 anos recolhemos 31 casos de ateroembolia. 5 deles, postoperatórias e 26 casos com origens diferentes: 20 devido à aorta Shaggy e 6 por outras causas. Das 20 com aorta Shaggy, 10 apresentavam ateroembolia. 22 dos 26 casos não iatrogênicos foram tratados via endovascular, com uma mortalidade de 9%. De acordo com as nossas observações, comentamos as condutas e variações no tratamento, propondo uma classificação que inclua os casos assintomáticos para o tratamento precoce destas lesões aórticas, antes de produzir complicações severas por ateroembolias ou síndromes isquêmicos dos miembros inferiores. Comentamos os truques que aprendemos com a observação dos diferentes casos selecionados.

Ateroembolism is not a very well known entity and its prognosis is poor, especially in cases of disseminated ateroembolism, and also in cases of distal ateroembolism which causes aninflammatory syndrome of systemic response. 31 cases of ateroembolism were registered during 14 years, 5 were post-surgical and 26 due to different etiologies: 20 due to shaggy aorta and 6 due to other reasons. Of the 20 cases with shaggy aorta, 10 presented ateroembolism. 22 of the 26 non-iatrogenic cases were treated with the endovascular approach with a 9% mortality. According to our observations, we discussed our approach and treatment options, suggesting a classification which includes asymptomatic cases for early treatment of these aortic lesions, before they induce severe ateroembolic complications or lower limb ischemic syndromes. Likewise, we discuss some tips learnt during the observation of the different cases commented.

Cutaneous Cholesterol Embolism / 대한피부과학회지

A cholesterol embolism is a systemic disease resulting from the occlusion of arteries by cholesterol crystals released from atheromatous plaques. It has been associated with inflammation, sheering forces from blood flow due to hypertension, aneurysm formation, infection, mechanical manipulation during surgery or vascular procedures, and anticoagulation. We report a case of a cutaneous cholesterol embolism in a 66-year old man who had purpuric skin lesions on both feet associated with diabetes mellitus, hypertension, and anticoagulation for a cerebral infarction.

Embolización cutánea por microcristales de colesterol: presentación de un caso y revisión de la literatura / Cholesterol cutaneous crystal embolization: a case report and literature review

La embolización de cristales de colesterol genera un síndrome multiorgánico inespecífico, severo, relativamente infrecuente y de difícil diagnóstico. Se produce por la oclusión de pequeños vasos en diferentes sistemas, entre ellos la piel, órgano diana frecuente. Se comunica el caso de un varón de 69 años con múltiples factores de riesgo cardiovascular y varios eventos desencadenantes que presentó embolización por microcristales de colesterol con compromiso cutáneo y renal.

Cholesterol crystal embolization is a rare and severe multiorganic syn-drome of diffi cult diagnosis. It occurs as a result of the occlusion of smallvessels in diff erent organs, being the skin a frequent diana.We present the case of a 69 years-old male with multiple cardiovascularrisk factors and many precipitant events. He developed cholesterol em-bolization syndrome with cutaneous and renal involvement.

Surgical treatment of 154 patients with non-traumatic acute lower limb ischemia / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the surgical treatment and prognosis of non-traumatic acute lower limb ischemia, and compare the morbidity and prognosis of acute arterial embolism and acute arterial thrombosis.</p><p><b>METHODS</b>The clinical data of 154 acute lower limb ischemia patients surgically treated from July 1999 to December 2007 were retrospectively analyzed. Fogarty catheter embolectomy was used in all patients; in which, 128 cases underwent Fogarty catheter embolectomy only, 8 cases Fogarty catheter embolectomy combined with endarterectomy, 13 cases Fogarty catheter embolectomy combined with vascular reconstruction with prosthetic graft or great saphenous vein, 5 cases Fogarty catheter embolectomy combined with amputation. The patients were divided into two groups according to pathogenesis: acute arterial embolism group (99 cases) and acute arterial thrombosis group (55 cases). The morbidity, amputation, perioperative mortality rates and high risk factors of amputation in the two groups were compared.</p><p><b>RESULTS</b>Female experienced acute arterial embolism more often than man (60.6% vs 39.4%, P < 0.05), and more acute arterial thrombosis occurred in man (72.7% vs 27.3%, P < 0.05). The amputation rate of all cases was 9.7%, and perioperative mortality rate was 11.7%. The amputation rate in acute arterial embolism group was lower than acute arterial thrombosis group (5.1% vs 18.2%, P < 0.05). The perioperative mortality rates in the two groups were equal (11.1% vs 12.7%, P > 0.05). The statistically high risk factor of amputation for two groups was ischemic time, and smoking and diabetes were high risk factors for acute arterial thrombosis.</p><p><b>CONCLUSIONS</b>Men experiences acute arterial thrombosis more often, and women experiences acute arterial embolism more often. The amputation rate of acute arterial embolism is lower than acute arterial thrombosis, and acute arterial thrombosis has more high risk factors of amputation.</p>

Granulocyte colony stimulating factor attenuated myocardial apoptosis via Janus kinase 2/signal transducer and activator of transcription signal transduction pathway in rats with coronary microembolization / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the effects of granulocyte colony stimulating factor (G-CSF) on myocardial apoptosis following coronary microembolization (CME) and possible role of Janus kinase/singnal transducer and activator of transcription (JAK/STAT) pathway in this process.</p><p><b>METHODS</b>A total of 92 male Sprague Dawley rats were randomized into CME (n = 24), G-CSF (100 microg x kg(-1) x d(-1) i.p. 2 hours post CME for 5 days, n = 24), JAK2 inhibitor AG490 (G-CSF plus AG490, 5 mg x kg(-1) x d(-1) i.p. 2 hours post CME for 5 days, n = 24), all rats received left ventricular injection of homologous microthrombotic particle suspension post clamping the ascending aorta. Sham-operated group (n = 20) served as control. The rats were sacrificed at day 3, 7, 14 and 28 after operation. The myocardial mRNA expressions of Bcl-2, Bax, Fas, FasL and GAPDH which was used as the intercomparison, were evaluated by real time PCR. The ratio of Bcl-2/Bax was compared. The protein expression of Caspase-3, cleaved PARP, t-JAK2, p-JAK2, t-STAT3 and p-STAT3 were detected by western blot. Myocardial apoptosis were examined by TUNEL staining.</p><p><b>RESULTS</b>Compared with Sham rats, the mRNA of Bcl-2, Bax, Fas and FasL significantly increased whereas the ratio of Bcl-2/Bax (0.28 +/- 0.04 vs. 2.98 +/- 0.49) significantly decreased and the protein expression of Caspase-3 (0.762 +/- 0.129 vs. 0.133 +/- 0.027), PARP (0.992 +/- 0.146 vs. 0.386 +/- 0.074) and the myocardial apoptosis index (17.2 +/- 1.9 vs. 1.2 +/- 0.6) significantly increased in CME hearts (all P < 0.05). rhG-CSF significantly attenuated CME induced changes and cotreatment with JAK2 inhibitor AG490 abolished the effects of rhG-CSF. The protein expressions of t-JAK2 and t-STAT3 among the groups were similar. P-JAK2 and p-STAT3 protein expressions were significantly increased in G-CSF group compared to other groups (P < 0.05).</p><p><b>CONCLUSION</b>G-CSF attenuated myocardial apoptosis induced by CME via JAK2/STAT3 pathway.</p>

[Endo arterial investigation: warning for the cholesterol crystal embolism disease]

Cholesterol crystal embolism [CCE] is a rare disorder which can complicate cardiac catheterization, angiographic studies and cardiovascular surgery. The CCE exposes to a great risk of renal failure and it can even threaten life by means of a multi visceral failing syndrome. Report a new case of CCE following cardiac catheterization. We report the observation of a 63-year-old patient who had a coronary angiography via the right femoral artery after a myocardial infarction. This examination has showed a multi-vessel coronary disease. 15 days later, the patient presented purplish and painful discoloration of his toes. The laboratory findings showed a mild inflammatory syndrome and eosinophilia at 700/micro L. There wasn't a renal dysfunction nor proteinury nor hematury. We performed a skin biopsy and made the diagnosis of CCE. Trans oesophageal echography objectified an irregular atherosclerotic plaque in the isthmic aorta, The CT scan revealed a spindle-shaped aneurysm in the end of the abdominal aorta. This aneurysm contains a marginal surrounding thrombosis with high embolic risk. The patient was put under clopidogrel, enoxaparine, simvastatine, colchicine and atenolol and operated successfully. The two particularities of this observation are, on one hand, the absence of a renal involvment, which represents the main prognostic factor of the CCE. On the other hand, the CCE has revealed a very unstable aneurysm of the aorta which could be complicated during the cardiac catheterisation. The CCE is a difficult diagnosis that must be remembered before any cardiac catheterisation, because it often reflects unstable aortic atherosclerotic lesions

Meta-analysis of mesenteric arterial embolism or mesenteric arterial thrombosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics of mesenteric arterial embolism (MAE) and mesenteric arterial thrombosis (MAT), and to clarify the diagnosis and treatment status of MAE and MAT in China.</p><p><b>METHODS</b>A retrospective analysis of 111 cases suffering from MAE or MAT was performed. Data of these cases were collected from Chinese Journal Full-text Database from 1994 to 2006.</p><p><b>RESULTS</b>There were 61 cases (54.9%) with MAE and 50 cases (45.1%) with MAT. Fifty-two patients (46.8%) had arterial fibrillation. Ninety-seven cases (87.4%) were diagnosed by exploratory laparotomy or autopsy, and 14 cases (12.6%) by imageology. Embolism or thrombosis in superior mesenteric artery (SMA) accounted for 92.8%, 4.5% in SMA plus inferior mesenteric artery. 15.2%(14/92) necrosis were located in jejunum or ileum, 39.1%(36/92) in jejunum and ileum, 38.0%(35/92) in jejunum, ileum and colon. Thrombolysis or anticoagulation in artery were operated in 7 cases(6.3%). Extraction of embolism or thrombosis in operation were implemented in 18 cases(16.2%). Intestinal resection were finished in 76 cases(68.5%). Sixty-eight patients (61.3%) were misdiagnosed. Sixty-three cases (60.6%) died.</p><p><b>CONCLUSION</b>The manifestation of MAE or MAT is quite complicated and changeable, so that many cases are misdiagnosed. The clinic and image characteristics of MAE and MAT have not been well known by doctors.</p>

A Case of Pseudoaneurysm of the Common Carotid Artery Associated with Central Venous Catheterization in a Patient on Hemodialysis / 대한신장학회지

Aneurysm of the carotid artery is an uncommon clinical disease which can occur as the result of atherosclerotic degeneration, fibromuscular dysplasia, or traumatic injury. Because of the risk of aneurysm rupture as well as the neurological sequelae caused by cerebral atheroembolism, surgical intervention is usually required. Internal jugular vein cannulation is the preferred approach for temporary hemodialysis catheter placement. However, the patient with renal failure on hemodialysis who has comorbid condition, the risk of pseudoaneurysm of carotid artery is increased. Here we report a patient on hemodialysis who developed common carotid artery pseudoaneurysm following an attempted internal jugular vein catheterization. A review of relevant literature is also presented.