Acute Thrombotic Occlusion of the Left Brachial Artery After Intra-Arterial Administration of Amiodarone
| Autor: | Marco Witkowski, Ursula Rauch, Ulf Landmesser, Wulf Knie, Hans-Christian Mochmann, Carsten Skurk |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Brachial Artery Amiodarone Critical Care and Intensive Care Medicine Ventricular tachycardia Compartment Syndromes Internal medicine medicine.artery Antithrombotic medicine Humans Infusions Intra-Arterial Brachial artery medicine.diagnostic_test business.industry Thrombosis Emergency department Middle Aged medicine.disease Angiography Tachycardia Ventricular Cardiology Female Tomography X-Ray Computed business Anti-Arrhythmia Agents medicine.drug |
| Zdroj: | Critical Care Medicine. 44:e227-e230 |
| ISSN: | 0090-3493 |
| Popis: | 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. DESIGN Case report. SETTING Prehospital setting, emergency department and ICU of a university hospital. PATIENT 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. INTERVENTIONS Immediate left brachial artery angiography with subsequent thrombectomy was performed. MEASUREMENTS AND MAIN 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. |
| Databáze: | OpenAIRE |
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