[Arterial spasm caused by administration of DHE-heparin in a tibial fracture]

A 38 years old white woman suffered a tibial fracture which was primarily managed by traction therapy. 3 X 5000 IU Heparin DHE was given as prophylaxis against thromboembolism. 6 days after administration of the drug a severe arterial spasm (documented by arteriography) with high-grade ischaemia of the left leg occurred. Successful arterial dilatation with a Fogarty catheter within the entire infragenual region down to the foot arteries was performed and consecutively during the same anaesthesia the intramedullary stabilisation using an interlocking nail was also performed. 8 months later the patient was free from symptoms, the fracture had healed, and the function was unrestricted. All pulses were palpable and the ultrasound Doppler index was greater than 1. In conclusion, we recommend in arterial spasm during heparin DHE therapy, immediate operative exposure of the vessel--if possible under local anaesthesia--and adequate vascular surgery as balloon catheter dilatation.