Delayed arterial thrombosis following an apparently trivial low-voltage electric injury

Vascular damage is a frequent and serious complication following high voltage injuries (greater than 1000 V), but does not seem to have been described with low-voltage current. We report an unusual case with delayed thromboses in the hand arteries of a young, healthy 24 yo man, after a 220 V electric shock. Two weeks after the accident he developed a successively increasing hand ischemia with Raynaud phenomenon, and finally fingertip necroses. Angiography revealed multiple small vessel occlusion. Although systemic fibrinolysis with streptokinase was not initiated until eight weeks after the accident, a partial restitution of the markedly reduced macro- and microcirculation in the fingers was possible. The blood pressure of the ischemic fingers increased from 0 to 40 mmHg, with total relief of symptoms. Concomitantly, a marked improvement of the skin microcirculation could be objectively demonstrated by laser Doppler fluxmetry and dynamic capillaroscopy. Three conclusions can be made 1) low-voltage electric shock can initiate late vascular thromboses, 2) thrombolysis can be effective also weeks after the thromboses have been established, and 3) the improvement of the nutritional circulation in the ischemic areas can be nicely and objectively documented by the two methods described.