Molkara Afshin M, Abou-Zamzam Ahmed M, Teruya Theodore H, Bianchi Christian, Killeen J David
Division of Vascular Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Ann Vasc Surg. 2006 Nov;20(6):803-8. doi: 10.1007/s10016-006-9133-9.
Chronic use of ergot alkaloids has been recognized as a rare cause of lower extremity ischemia. Most patients with ergot toxicity present with symptoms of lower extremity claudication. Herein we present a woman with bilateral lower extremity rest pain and a history of chronic ergot use for migraine headaches. Arteriography demonstrated extensive pruning of the distal arterial tree along with bilateral external iliac artery dissections - a finding that is not often associated with young, normotensive patients with chronic ergot toxicity. This patient was treated with endovascular stenting of the dissections along with cessation of ergot. Her symptoms improved markedly, and follow-up arteriography 6 weeks later demonstrated resolution of the iliac dissections along with restoration of nearly normal lower extremity runoff vessels. Discontinuation of ergot-containing products and cessation of tobacco and caffeine use is the cornerstone of therapy in chronic ergot toxicity. The association of ergot toxicity and iliac dissection has not been previously described. Endovascular or surgical interventions may be considered in patients with ergot toxicity for specific indications or those whose symptoms progress despite conservative management.
长期使用麦角生物碱已被确认为下肢缺血的罕见病因。大多数麦角中毒患者表现为下肢间歇性跛行症状。在此，我们报告一名患有双侧下肢静息痛且有长期使用麦角治疗偏头痛病史的女性。动脉造影显示远端动脉树广泛变细，同时伴有双侧髂外动脉夹层形成——这一发现并不常见于患有慢性麦角中毒的年轻、血压正常的患者。该患者接受了夹层的血管内支架置入治疗，并停用了麦角。她的症状明显改善，6周后的随访动脉造影显示髂动脉夹层消失，下肢血流几乎恢复正常。停用含麦角的产品以及戒烟和停用咖啡因是慢性麦角中毒治疗的基石。麦角中毒与髂动脉夹层的关联此前尚未见报道。对于有特定指征的麦角中毒患者或那些尽管进行了保守治疗但症状仍进展的患者，可考虑进行血管内或手术干预。
