1995 Volume 38 Issue 5 Pages 383-388
A 55-year-old female diabetic patient was admitted to Kitasato University Hospital with a diagnosis of diabetic coma. She had a 10-year history of NIDDM and was being treated with insulin (20 U per day). She had discontinued insulin injection for a few days before admission because of appetite loss and vomiting. On admission, physical examination disclosed arterial obstruction in the right leg. Fogarty catheter thrombectomy was performed along with fluid replacement and insulin supplementation, and a large number of thrombi were removed. Despite the patency of the main artery after thrombectomy, peripheral blood circulation could not be achieved. Urokinase thrombolytic therapy was then instituted, but failed to restore peripheral blood circulation in the affected leg. The patient developed disseminated intravascular coagulopathy, and ultimately above-the-knee amputation of the leg saved her life. Both the preoperative angiographic findings and the results of pathohistological examination of the amputated leg showed only minimal arteriosclerotic changes. We concluded that the mechanism of arterial occlusion in this case was based mainly on a hypercoaguable state (hemostatic factor) associated with diabetic coma, and not on endothelial damage due to atherosclerosis and arteriosclerosis (vascular factor).
