Surgical Clinic, University of Brescia, 25123, Brescia, Italy.
Thromb J. 2011 Aug 30;9:13. doi: 10.1186/1477-9560-9-13.
The ergotamine tartrate associated with certain categories of drugs can lead to critical ischemia of the extremities. Discontinuation of taking ergotamine is usually sufficient for the total regression of ischemia, but in some cases it could be necessary thrombolytic and anticoagulant therapy to avoid amputation.
A woman of 62 years presented with a severe pain left forearm appeared 10 days ago, with a worsening trend. The same symptoms appeared after 5 days also in the right forearm. Physical examination showed the right arm slightly hypothermic, with radial reduced pulse in presence of reduced sensitivity. The left arm was frankly hypothermic, pulse less on radial and with an ulnar humeral reduced pulse, associated to a decreased sensitivity and motility.Clinical history shows a chronic headache for which the patient took a daily basis for years Cafergot suppository (equivalent to 3.2 mg of ergotamine).From about ten days had begun therapy with itraconazole for vaginal candidiasis. The Color-Doppler ultrasound shown arterial thrombosis of the upper limbs (humeral and radial bilateral), with minimal residual flow to the right and no signal on the humeral and radial left artery.
Angiography revealed progressive reduction in size of the axillary artery and right humeral artery stenosis with right segmental occlusions and multiple hypertrophic collateral circulations at the elbow joint. At the level of the right forearm was recognizable only the radial artery, decreased in size. Does not recognize the ulnar, interosseous artery was thin. To the left showed progressive reduction in size of the distal subclavian and humeral artery, determined by multiple segmental steno-occlusion with collateral vessels serving only a thin hypotrophic interosseous artery.Arteriographic findings were compatible with systemic drug-induced disease. The immediate implementation of thrombolysis, continued for 26 hours, with heparin in continuous intravenous infusion and subsequent anticoagulant therapy allowed the gradual disappearance of the symptoms with the reappearance of peripheral pulses.
Angiography showed regression of vasospasm and the resumption of flow in distal vessels. The patient had regained sensitivity and motility in the upper limbs and bilaterally radial and ulnar were present.
酒石酸麦角胺与某些类别的药物联用可导致肢体严重缺血。停用麦角胺通常足以使缺血完全消退，但在某些情况下，可能需要进行溶栓和抗凝治疗以避免截肢。
一名62岁女性10天前出现左前臂剧痛，且呈加重趋势。5天后右前臂也出现了同样的症状。体格检查显示右臂轻度体温过低，桡动脉搏动减弱，感觉减退。左臂明显体温过低，桡动脉无搏动，尺肱动脉搏动减弱，伴有感觉和活动能力下降。临床病史显示患者有慢性头痛，多年来每天服用卡啡因栓剂（相当于3.2毫克麦角胺）。大约十天前开始用伊曲康唑治疗阴道念珠菌病。彩色多普勒超声显示上肢动脉血栓形成（双侧肱动脉和桡动脉），右侧残余血流极少，左侧肱动脉和桡动脉无信号。
血管造影显示腋动脉和右肱动脉管径逐渐减小，右侧节段性闭塞，肘关节处有多个肥厚的侧支循环。在右前臂水平仅可识别桡动脉，其管径减小。未识别出尺动脉，骨间动脉变细。左侧显示锁骨下动脉远端和肱动脉管径逐渐减小，由多个节段性狭窄闭塞所致，侧支血管仅供应一条细小的发育不良的骨间动脉。血管造影结果与全身性药物性疾病相符。立即实施溶栓治疗，持续26小时，持续静脉输注肝素并随后进行抗凝治疗，症状逐渐消失，外周脉搏重新出现。
血管造影显示血管痉挛消退，远端血管血流恢复。患者上肢恢复了感觉和活动能力，双侧桡动脉和尺动脉均存在。
