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Occult ischaemic necrosis of skeletal muscle associated with renal failure.

Case reports Case I-A 61 year old man developed thrombosis in a right femoropopliteal bypass graft necessitating below knee amputation. There were no muscle symptoms or signs and no loss of pulsation in the remaining leg. Twenty four hours postoperatively he became oliguric, acidotic, and hyperkalaemic. Serum creatine kinase activity was >10000 U/I (normal <190 U/1). He developed oliguric renal failure, which was managed by haemofiltration for nine days and then haemodialysis for 28 days. Biopsy of the left anterior tibial muscle 14 days postoperatively showed necrosis of isolated muscle fibres (figure) with some regenerating fibres. He regained normal renal function.