title: Successful thrombolysis and spasmolysis of acute leg ischemia after accidental intra-arterial injection of dissolved flunitrazepam tablets.
abstract: A 37-year-old man with known intravenous drug abuse presented in the surgical ambulatory care unit with acute leg ischemia after accidental intra-arterial injection of dissolved flunitrazepam tablets into the right femoral artery. A combination of anticoagulation, vasodilatation, and local selective and superselective thrombolysis with urokinase was performed to salvage the leg. As a result of the severe ischemia-induced pain, the patient had to be monitored over the complete therapy period on the intensive care unit with permanent administration of intravenous fluid and analgetics. We describe the presenting symptoms and the interventional technique, and we discuss the recent literature regarding the management of accidental intra-arterial injection of dissolved flunitrazepam tablets.
authors.affiliation: Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Boris_radeleff@med.uni-heidelberg.de
authors.forename: B
authors.initials: B
authors.lastname: Radeleff
authors.forename: U
authors.initials: U
authors.lastname: Stampfl
authors.forename: C-M
authors.initials: CM
authors.lastname: Sommer
authors.forename: N
authors.initials: N
authors.lastname: Bellemann
authors.forename: A
authors.initials: A
authors.lastname: Hyhlik-Duerr
authors.forename: M-A
authors.initials: MA
authors.lastname: Weber
authors.forename: D
authors.initials: D
authors.lastname: Boeckler
authors.forename: H-U
authors.initials: HU
authors.lastname: Kauczor
mesh_terms: D000208:Acute Disease; D000328:Adult; D000527:Alprostadil / Q000627:therapeutic use; D000779:Anesthetics, Local; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005445:Flunitrazepam / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007269:Injections, Intra-Arterial; D007511:Ischemia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D007866:Leg / Q000098:blood supply*; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D011859:Radiography; D019966:Substance-Related Disorders; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014661:Vasoconstriction / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000779:Anesthetics, Local; D014151:Anti-Anxiety Agents; D005343:Fibrinolytic Agents; D014665:Vasodilator Agents; D005445:Flunitrazepam; D008012:Lidocaine; D014568:Urokinase-Type Plasminogen Activator; D000527:Alprostadil