Acute limb ischaemia due to vasospasm: a rare presentation

Abstract

A 30-year-old woman with active intravenous drug use presented with pain, blue discolouration, paresthesia and lack of grip strength of left hand for 1 week. Physical examination revealed blue discolouration, decreased sensation and cold to touch in the left hand. She had no palpable radial pulse. She admitted Heroin use only but the urine drug screen was also positive for amphetamine. CT angiogram of the left upper extremity was concerning for acute ischaemia due to arterial occlusion. The initial plan was for amputation. However, to salvage the limb with thrombolysis, an interventional radiology angiogram was performed. The angiogram demonstrated diffuse arterial spasm and response to nitroglycerin. She was treated with nitroglycerin drip and transitioned to a calcium channel blocker. She did improve significantly. To ensure no embolic sequelae, the patient was discharged with a month of oral anticoagulation.

Methamphetamine spasm in the large caliber arteries—the severity is likely underestimated

“…Among the resultant chronic problems, congestive heart failure, cognitive decline, and Parkinson syndrome are common. 5 , 6 , 7 , 8 , 9 It is useful to know that as a medication, amphetamine and its derivatives or analogs are commonly used in the treatment of attention deficit/hyperactivity disorder, narcolepsy, and other psychiatric diseases. These medications are also used as an appetite suppressor.…”

“…Patients can experience headache, abdominal pain, arterial dissection, hemorrhagic and ischemic stroke, Raynaud syndrome, finger and/or toe gangrene, chest tightness, angina, arrhythmia, and myocardial infarction, all of which can represent peripheral artery-related side effects. 3 , 4 , 5 , 6 , 7 , 8 , 9 Disturbing side effects can also develop in the central nervous system, such as insomnia, anorexia, and irritability. Sympathomimetic drugs are highly addictive, and, once started, the patient could be reluctant to stop taking them.…”

“…Severe arterial vasospasm is documented in the smaller, peripheral arteries in several studies. 3 , 4 , 5 , 6 , 7 , 8 , 9 Involvement of the large diameter aorta and iliac arteries and the severity are much less documented and reported. We present two cases of severe large arterial vasospasm that developed after methamphetamine ingestion to alert vascular surgeons to the unique and potentially drastic presentation.…”