title: Acute Thrombotic Occlusion of the Left Brachial Artery After Intra-Arterial Administration of Amiodarone.
abstract: OBJECTIVE
  To report a case of intra-arterial amiodarone injection in a hemodynamically unstable patient leading to acute vessel occlusion and a subsequent compartment syndrome.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Prehospital setting, emergency department and ICU of a university hospital.
  
  
  METHODS
  A 58-year-old woman presenting with a ventricular tachycardia of 190 beats/min was administered amiodarone through an accidently placed arterial access in the left cubital fossa. Quickly, the woman developed clinical signs of an acute arterial occlusion.
  
  
  METHODS
  Immediate left brachial artery angiography with subsequent thrombectomy was performed.
  
  
  RESULTS
  A thrombotic occlusion at the injection side was found, which was immediately recanalized by thrombus aspiration. In addition to anticoagulation and an adenosine diphosphate-antagonist an adjunct therapy with vasodilators and gpIIb/IIIa inhibitors was given and repetitive duplex sonography confirmed arterial flow. However, despite restoration of blood flow the patient developed a severe compartment syndrome of the arm and had to receive multistep surgical interventions.
  
  
  CONCLUSIONS
  This is the first report of an acute thrombotic vessel occlusion leading to a compartment syndrome upon accidental intra-arterial injection of amiodarone in an emergency setting. In the hemodynamically unstable patient healthcare providers should be aware of arterial miscanulation and its consequences. Upon intra-arterial injection, a direct antithrombotic and vasodilative therapy should be administered via the initially misplaced arterial access, which may include a gpIIb/IIIa inhibitor.
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Witkowski
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Mochmann
authors.forename: Ursula
authors.initials: U
authors.lastname: Rauch
authors.forename: Wulf
authors.initials: W
authors.lastname: Knie
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.forename: Carsten
authors.initials: C
authors.lastname: Skurk
mesh_terms: D000638:Amiodarone / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001916:Brachial Artery / Q000000981:diagnostic imaging; D003161:Compartment Syndromes / Q000209:etiology*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects*; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000150:complications / Q000188:drug therapy; D013927:Thrombosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone