Fatal Vasospasm of the Coronary Arteries in a Patient Undergoing Distal Bypass Surgery and Endovascular Therapy for Threatened Lower Limbs Due to Acute Exacerbation of Peripheral Arterial Disease

Daisuke Takeyoshi; Shinsuke Kikuchi; Keisuke Miyake; Takamitsu Tatsukawa; Daita Kobayashi; Daiki Uchida; Yuya Kitani; Hiroyuki Kamiya; Nobuyoshi Azuma

doi:10.3400/avd.cr.18-00050

Fatal Vasospasm of the Coronary Arteries in a Patient Undergoing Distal Bypass Surgery and Endovascular Therapy for Threatened Lower Limbs Due to Acute Exacerbation of Peripheral Arterial Disease

Ann Vasc Dis. 2018 Sep 25;11(3):369-372. doi: 10.3400/avd.cr.18-00050.

Authors

Daisuke Takeyoshi¹, Shinsuke Kikuchi², Keisuke Miyake², Takamitsu Tatsukawa¹, Daita Kobayashi¹, Daiki Uchida², Yuya Kitani³, Hiroyuki Kamiya¹, Nobuyoshi Azuma²

Affiliations

¹ Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
² Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
³ Department of Cardiology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.

Abstract

A 79-year-old man with a heavy smoking history presented with threatened lower limbs due to acute exacerbation of peripheral artery disease (PAD). He underwent emergent distal bypass surgery for the right leg and external iliac stenting for the left leg. Fatal coronary artery spasm (CAS) with ST segment changes on electrocardiography was observed 28 h after the procedures, resulting in cardiac arrest. Coronary angiography showed widespread CAS with improvement after intra-arterial nitroglycerin infusion. We should keep in mind that CAS may occur more frequently than expected in PAD patients, especially those who have not stopped smoking prior to revascularization.

Keywords: coronary artery spasm; peripheral artery disease; smoking.