[Acute ischemia of the extremities and drug addiction]

It is not unusual to find ischemia of limbs in drug addicts and two new cases are reported, together with a literature review, allowing analysis of physiopathologic mechanisms and therapeutic modalities. The first case was a 20 year old man who presented with sensory-motor ischemia of the right hand after injection of heroin into the radial artery. Arteriography showed partial occlusion of the deep palmar arch and all collateral arteries of fingers. Regression of ischemia followed administration of thrombolytics, heparin and vasodilators, arteriography showing restoration of palmar arch and digital arteries flow apart from that of the 4th finger. The latter developed distal necrosis which required, in spite of thoracic sympathectomy, amputation of the 3rd phalanx. Histology of amputation piece showed presence of intra-arterial foreign bodies. The second case was a 30 year old man who presented with an acute sensory-motor ischemia of left calf and foot after injection of heroin into the retromalleolar groove. Arteriography showed absence of opacification of vascular axes in the middle third of leg and an atheromatous plaque in left main iliac artery. Heparin therapy plus lumbar sympathectomy resulted in reheating of the foot, but ischemia recurred one month later. A repeat arteriography with oblique images demonstrated that the plaque in the main iliac artery was larger than it appeared in frontal images and that an embolus had developed in the deep femoral artery. Final treatment in this patient involved an inter-femoral saphenous vein bypass and amputation of 4th toe. Histology of amputation piece showed only a banal arterial thrombosis without foreign body.(ABSTRACT TRUNCATED AT 250 WORDS)