An effective treatment protocol for intraarterial drug injection

Abstract

Between 1972 and 1988, 48 patients with extremity ischemia after an intraarterial drug injection were treated with the following protocol: heparin, dextran 40, dexamethasone, elevation, and early mobilization of the extremity. A tissue ischemia score, derived by assessing the color, capillary refill, sensory function, and temperature of the extremity, was used to assess the ischemic injury. Each sign was scored either normal = 0 or abnormal = 1; then summed to provide the tissue ischemia score (range, 0 to 4). Twenty-four (50%) patients had an extremity tissue ischemia score less than or equal to 2. After treatment 22 of the 24 patients had a normal extremity, and 2 required limited digital amputations. In this group, outcome was comparable regardless of the time interval from intraarterial drug injection to treatment. Ten of 24 (50%) patients with an extremity tissue ischemia score greater than 2 had a normal extremity, 3 had a functional deficit, and 11 required digital amputations. Twelve of the 24 patients were treated within 24 hours and had a significantly superior outcome when compared to the 12 who were treated more than 24 hours after intraarterial drug injection (p less than 0.001, Fisher's exact test). The tissue ischemia score is a useful predictor of extremity outcome in patients with intraarterial drug injection. The outlined treatment protocol is effective in minimizing tissue injury caused by intraarterial drug injection. Institution of treatment within 24 hours of intraarterial drug injection is particularly important in patients who manifest severe ischemia.

Upper Limb Morbidity as a Direct Consequence of Intravenous Drug Abuse

“…14 IADI should also be suspected if the patient uses arterial pulsations to identify injecting sites, if the aspiration of blood was a brighter red than usual, and if the euphoric sensation was absent post-injection. 14 The pathophysiology of ischaemia secondary to intra-arterial injection is multifactorial. Direct toxic effect of the drug produces an endarteritis, endothelial injury, platelet activation, vasospasm and localised thrombosis.…”

Cutaneous complications of intravenous drug abuse

“…This is particularly the case when oral drug formulations such as crushed tablets are injected. The result is a peripheral ischaemia, oedema and compartment syndrome, which worsen the ischaemia 73–80 …”

“…In the case of compartment syndrome, urgent surgical decompression is indicated. Many treatments have been used including vasodilators, anticoagulants, corticosteroids, prostaglandin inhibitors, and others 73–80 …”

Necrosis of the 4th and 5th Digits after Intra-Articular Injection of Diazepam into the Wrist

“…Dextrans [19] and aspirin, usually starting on day 4-5, have also been proposed [20]. Application of high-dose systemic corticosteroids is part of some treatment schemes [20].…”

“…Application of high-dose systemic corticosteroids is part of some treatment schemes [20]. Hyperbaric oxygen therapy has been reported to have an effect on the malperfused areas by Adir et al [21] but failed to show effect in the report from Chang and Lin [22].…”