Beneficial effects of intra-arterial reserpine after upper-extremity embolectomy: a prospective randomised trial

Persistent ischaemia occasionally follows technically-successful arterial embolectomy, and has generally been ascribed to small-vessel thrombosis in the distal vascular bed. Because of the possibility that distal vasospasm might be a contributory cause, we conducted a prospective randomised trial of vasodilator therapy in this setting. In 50 consecutive patients presenting with their first episode of upper-extremity arterial embolism, we compared the results of the intra-arterial instillation of 0.5 mg reserpine with those of saline alone following embolectomy. Among 29 patients receiving saline only, 13 (44.8%) suffered persistent or recurrent limb ischaemia requiring reoperation, while three (14.3%) of 21 patients receiving reserpine had continuing ischaemia (P = 0.02). Three patients in each group required a second re-operation; all three in the reserpine group were ultimately found to have a proximal axillo-subclavian artery stenosis as the cause for their persistent or recurrent limb ischaemia. Although its underlying pathophysiology remains obscure, peripheral vasospasm appears to accompany acute embolic arterial occlusion. Manoeuvres to prevent or reverse such distal vasoconstriction may be useful in avoiding persistent or recurrent ischaemia following arterial embolectomy.