[Acute ischemia of the hand after intra-arterial injection of flunitrazepam. Local combined fibrinolysis therapy in three cases]

Author(s): Hering J, Angelkort B

Affiliation(s): Medizinische Klinik Nord, Angiologie/Diabetologie, Klinikum Dortmund gGmbH. angiologie@klinikumdo.de

Publication date & source: 2006-06-16, Dtsch Med Wochenschr., 131(24):1377-80.

Publication type: Case Reports

HISTORY AND ADMISSION FINDINGS: Three drug addicts presented as emergencies with severe pain in one hand. 1 to 3 hours previously they had accidentally injected dissolved flunitrazepam tablets intra-arterially. The affected hands were pale and cold. Two of the patients had injected into the brachial artery, one into the radial artery. DIAGNOSTICS: The brachial and radial arteries were palpable in all three patients, but immediate angiography showed complete occlusion of all arteries to the hand and fingers. TREATMENT AND COURSE: Initial local treatment with intra-arterial infusion of prostanoids (PGE(1)) did not improve hand perfusion. Subsequently, a combination of PGE(1) and local fibrinolytic therapy with rt-PA was given intra-arterially over 12 to 22 hours. In two of the patients complete reperfusion was achieved, but one, in whom the delay between injection and treatment had been the longest, lost the distal phalanges of digits 1, 2 and 3. No bleeding complications were observed. CONCLUSION: Peripheral ischemia as a result of an accidental intra-arterial injection of dissolved tablets in drug addicts is an emergency which requires immediate action. The combined administration of prostanoids and rt-PA-lysis is a promising therapeutic option that should be employed in such patients.