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Acute limb ischaemia due to vasospasm: a rare presentation
Raed Al Yacoub1, Jaymin Patel2, Neha Solanky2
1Department of Medicine, University of Florida, Gainesville, Florida, USA raed.alyacoub@medicine.ufl.edu.
BMJ Case Reports
|January 7, 2022
Summary
Intravenous drug use can cause acute limb ischemia due to arterial spasm, not just occlusion. Prompt intervention with vasodilators like nitroglycerin can successfully salvage the limb, avoiding amputation.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Toxicology
Background:
- Intravenous drug use is a risk factor for vascular complications.
- Acute limb ischemia presents with severe pain, discoloration, and sensory deficits.
Observation:
- A 30-year-old woman with a history of heroin and amphetamine use presented with acute left hand ischemia.
- Physical examination revealed blue discoloration, decreased sensation, and absent radial pulse.
- CT angiogram suggested acute arterial occlusion.
Findings:
- Interventional radiology angiogram revealed diffuse arterial spasm, not occlusion.
- The arterial spasm responded well to nitroglycerin.
- Treatment with nitroglycerin drip and calcium channel blockers led to significant clinical improvement.
Implications:
- Arterial spasm should be considered in acute limb ischemia associated with drug use.
- Vasoactive medications can be effective in limb salvage for drug-induced arterial spasm.
- Multidisciplinary management involving interventional radiology is crucial for limb salvage.
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