TY - JOUR
T1 - Cholesterol embolization syndrome and intra-abdominal bleeding immediately after initiation of hemodialysis
T2 - a case report with literature review
AU - Kakeshita, Kota
AU - Koike, Tsutomu
AU - Imamura, Teruhiko
AU - Arisawa, Yu
AU - Murai, Sayaka
AU - Shimizu, Ayako
AU - Kiyosawa, Taigo
AU - Yamazaki, Hidenori
AU - Kinugawa, Koichiro
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2020/12
Y1 - 2020/12
N2 - Background: Cholesterol embolization syndrome (CES) is a disease associating with the systemic cholesterol crystal embolism and end-organ dysfunction due to the atherosclerotic plaque rupture, which is dominantly triggered by the intravascular intervention. There is no consensus for which types of anticoagulants we should use during the hemodialysis in patients with CES and end-stage renal disease. Case presentation: We had a 68-year-old man with CES due to intravascular intervention, who suffered the omental bleeding, instead of the embolism, immediately after the initiation of hemodialysis with heparinization. An emergent laparotomy found active bleeding from the omentum, which was surgically repaired. The histopathological analysis showed the embolization of cholesterol crystal clefts in the omentum artery and the injury of arterial wall structure accompanied by the infiltration of inflammatory cells. We preferred nafamostat mesylate during hemodialysis and he had no adverse events following the surgery. Conclusions: It should be noticed that, in addition to the embolic events, bleeding events can develop in patients with CES, particularly following the initiation of hemodialysis with anticoagulation therapy.
AB - Background: Cholesterol embolization syndrome (CES) is a disease associating with the systemic cholesterol crystal embolism and end-organ dysfunction due to the atherosclerotic plaque rupture, which is dominantly triggered by the intravascular intervention. There is no consensus for which types of anticoagulants we should use during the hemodialysis in patients with CES and end-stage renal disease. Case presentation: We had a 68-year-old man with CES due to intravascular intervention, who suffered the omental bleeding, instead of the embolism, immediately after the initiation of hemodialysis with heparinization. An emergent laparotomy found active bleeding from the omentum, which was surgically repaired. The histopathological analysis showed the embolization of cholesterol crystal clefts in the omentum artery and the injury of arterial wall structure accompanied by the infiltration of inflammatory cells. We preferred nafamostat mesylate during hemodialysis and he had no adverse events following the surgery. Conclusions: It should be noticed that, in addition to the embolic events, bleeding events can develop in patients with CES, particularly following the initiation of hemodialysis with anticoagulation therapy.
KW - Blue toe
KW - Cholesterol crystal embolization
KW - Corticosteroid
KW - Heparin
UR - http://www.scopus.com/inward/record.url?scp=85096367870&partnerID=8YFLogxK
U2 - 10.1186/s41100-020-00305-9
DO - 10.1186/s41100-020-00305-9
M3 - 学術論文
AN - SCOPUS:85096367870
SN - 2059-1381
VL - 6
JO - Renal Replacement Therapy
JF - Renal Replacement Therapy
IS - 1
M1 - 53
ER -