Akute Ischämie nach intraarterieller Drogeninjektion

HISTORY AND CLINICAL FINDINGS: A 36-year-old patient presented with a severe hand ischemia after intraarterial injection of four dissolved tablets of Methylphenidate each 10 mg (Ritalin into the right radial artery. INVESTIGATIONS: Non-invasive vascular diagnostic demonstrated a normal perfusion of the radial and ulnar artery and a severe ischemia of the small vessels of the right hand. TREATMENT AND COURSE: Under suspicion of a combined vaso-spastic and thromboembolic arterial occlusion we started an intraarterial lysis therapy followed by anticoagulation with heparin and infusions of prostaglandines. Despite this therapy necroses of three fingers developed; partial amputation was followed by a good wound healing. CONCLUSIONS: Ischemia of an extremity after intraarterial injection of drugs is a vascular emergency.