外周血管介入术后合并胆固醇结晶性栓塞的临床分析

Clinical analysis of cholesterol crystal embolism after peripheral vascular intervention treatment

目的:观察外周血管介入后胆固醇结晶栓塞的发生情况、临床特点及治疗情况。方法:观察5例动脉粥样硬化患者介入术后,胆固醇结晶栓塞,急性肾衰竭、外周皮肤缺血性损害;5例均给与他汀类药物,激素治疗,其中3例患者给予肾替代治疗。收集其临床资料,并随访预后情况。结果:5例患者均在外周动脉介入治疗后出现血肌酐水平进行性升高,皮肤损害表现为肢端蓝紫色淤斑。3例患者的视网膜动脉可见胆固醇栓子。经治疗后4例患者肾功能逐步恢复正常,1例患者死亡,死亡原因是多脏器衰竭。结论:医源性胆固醇结晶栓塞的发病率逐渐增高,临床医生对此病应有足够的认识。

Objective:To observe the occurrence,clinical characteristics and treatment of cholesterol crystalline embolism after peripheral vascular interventions.Methods:Five patients with atherosclerosis who developed acute renal failure and peripheral skin ischemic damage after intervention were observed and diagnosed as cholesterol crystalline embolism,and all five patients were treated with statins and hormone therapy,and three of them were given renal replacement therapy.The clinical data were collected,and the prognosis was followed up.Results:All five patients showed progressive increase in blood creatinine level after peripheral arterial intervention,and skin damage was manifested as blue-purple bruises on the extremities.cholesterol emboli were seen in the retinal arteries of three patients.After treatment,renal function gradually returned to normal in four patients,while one patient died,and the cause of death was multi-organ failure.Conclusions:The incidence of medically induced cholesterol crystalline embolism is gradually increasing,and clinicians should have sufficient awareness of this disease.