Necrosis of the leg after intraarterial drug injection

Abstract

Inadvertent intraarterial injections in the context of drug abuse can cause damage to the vascular system. The clinical picture depends on the drug properties and ranges from partial ischemia to necrosis of the affected extremity. There are no current evidence-based guidelines regarding the management of intraarterial drug injections. In many cases the concept of solving vasospasm after injection is based on the use of intraarterial application of prostaglandins. We report a case in which a mixture of drugs was injected into the left femoral artery. The patient arrived 24 hours later with ischemia of the left leg at our emergency department. Angiography showed that there was no blood flowing in the leg. Despite intraarterial application of vasodilatators, regional neurolysis and thrombolyis with urokinase major amputation was unavoidable. The outcome after inadvertent injection depends on certain drug properties and the delay between injection and the beginning of therapy.

Intraarterial Injection of Drugs of Abuse into Femoral Artery: Case Report and Review of the Literature

“…Accidental or intentional arterial drug injection can cause a wide range of vascular complications, from simple vascular irritation to severe infections, thrombosis and gangrene. Most commonly upper extremity is involved, however there are occasional case reports of lower extremity injuries mainly in clandestine drug addicts [5,8]. Injecting drug via femoral vein puncture has been identified as more widespread than previously recognized and it is associated with considerable morbidity [4,9].…”

“…Various forms of medical treatment have been advocated including vasodilators, heparin and thrombolysis but with varied responses [3,5,7,11]. Haemodilution with low molecular weight dextran, continuous plexus blocks and regional nerve blocks for sympathicolysis and pain control, and corticosteroids were also applied, whereas sympathetic antagonists and hyperbaric oxygen therapy combined with antiplatelet agents have rarely been used [7,[11][12][13].…”

“…A literature search revealed that a generally accepted treatment algorithm for intra-arterial drug injection to stop critical ischaemia is missing [3,7,11]. Only case studies on the treatment of inadvertent injection of various drugs have been published so far [3,5]. The small number of patients involved in most of empiric studies made it difficult to develop an effective and well-accepted treatment protocol.…”

“…This complication, although well documented, is relatively rare and the series of case reports are small. The clinical picture depends on the drug properties and ranges from partial ischaemia to necrosis of affected extremity [5]. Limb ischaemia and subsequent tissue necrosis in drug abusers has been widely reported after intra-arterial injection of a number of substances including heroin and benzodiazepines tablets [6].…”