[Acute ischemia of the hand after intra-arterial injection of flunitrazepam. Local combined fibrinolysis therapy in three cases].
METHODS
Three drug addicts presented as emergencies with severe pain in one hand. 1 to 3 hours previously they had accidentally injected dissolved flunitrazepam tablets intra-arterially. The affected hands were pale and cold. Two of the patients had injected into the brachial artery, one into the radial artery.


METHODS
The brachial and radial arteries were palpable in all three patients, but immediate angiography showed complete occlusion of all arteries to the hand and fingers.


METHODS
Initial local treatment with intra-arterial infusion of prostanoids (PGE(1)) did not improve hand perfusion. Subsequently, a combination of PGE(1) and local fibrinolytic therapy with rt-PA was given intra-arterially over 12 to 22 hours. In two of the patients complete reperfusion was achieved, but one, in whom the delay between injection and treatment had been the longest, lost the distal phalanges of digits 1, 2 and 3. No bleeding complications were observed.


CONCLUSIONS
Peripheral ischemia as a result of an accidental intra-arterial injection of dissolved tablets in drug addicts is an emergency which requires immediate action. The combined administration of prostanoids and rt-PA-lysis is a promising therapeutic option that should be employed in such patients.
Hering
J
J
Medizinische Klinik Nord, Angiologie/Diabetologie, Klinikum Dortmund gGmbH. angiologie@klinikumdo.de
Angelkort
B
B
D000328:Adult; D000527:Alprostadil / Q000627:therapeutic use; D000792:Angiography; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005445:Flunitrazepam / Q000008:administration & dosage* / Q000009:adverse effects; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007269:Injections, Intra-Arterial / Q000009:adverse effects; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D012996:Solutions; D019966:Substance-Related Disorders / Q000150:complications; D013607:Tablets; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D014151:Anti-Anxiety Agents; D005343:Fibrinolytic Agents; D012996:Solutions; D013607:Tablets; D005445:Flunitrazepam; D010959:Tissue Plasminogen Activator; D000527:Alprostadil