Abstract:

Objective To report the diagnosis and treatment of one patient with acute left lower limb arterial embolism complicated with myonephropathic metabolic syndrome （MNMS）-associated heart failure， and to provide the reference for the diagnosis， anesthesia， and treatment of such patients. Methods The retrospective analysis on the clinical data， anesthesia methods， and perioperative management of one patient with acute left lower limb arterial embolism complicated with MNMS-associated heart failure was conducted， and the related literatures were reviewed. Results The patient， a 56-year-old male， was admitted to the hospital on March 25， 2017， due to sudden pain and numbness in the left lower limb accompanied by sensory and motor disturbances. The vascular ultrasound performed 35 min after the admission suggested a secondary thrombus from the distal superficial femoral artery to the entire popliteal artery. The laboratory tests performed 77 min after admission showed the myoglobin （MB） level was 698.7 μg·L^－1， cardiac troponin I （TnI） was 0.092 μg·L^－1， and creatine kinase isoenzyme （CK-MB） was 4.78 μg·L^－1. The electrocardiogram results taken 63 min after admission indicated tachycardia， left ventricular hypertrophy， atrial fibrillation， and atrioventricular block. The initial diagnosis was acute left lower limb arterial thrombosis， coronary artery disease， old myocardial infarction， arrhythmia， and type 2 diabetes. The patient was scheduled for an emergency thrombectomy of the left lower limb under general anesthesia 3 h after admission. During the surgery， the patient’s vital signs were stable， but 8 min after operation， the patient suddenly developed ventricular fibrillation， which was considered to be a reinfarction of acute myocardial infarction complicated with MNMS. After active rescue treatment， the patient’s life was still not saved. Conclusion For the patients with acute limb arterial embolism complicated with heart failure， timely restoration of limb blood supply is crucial in treatment. Appropriate fluid resuscitation to expand blood volume， maintaining electrolyte balance， and protecting cardiac and renal functions can effectively reduce the mortality and amputation rate of the patients.

Key words: Heart failure, Acute arterial embolism, Myonephropathic metabolic syndrome, Ischemia-reperfusion injury