Evaluation and Management of Peripheral
Annotation for Point R
Spasm of vessels distal to an arterial repair is common in young patients but usually does not threaten the viability of the distal extremity. Restoration of a normal hemodynamic state, reversal of hypothermia, and topical warming of the injured extremity will reverse arterial spasm in 6 hours to 8 hours in most patients. In rare patients, severe limb-threatening arterial spasm has been treated with a proximal intra-arterial bolus injection of 60-mg papaverine followed by an infusion of 30 mg/h to 60 mg/h in the past.38 Another option used on rare occasions has been a proximal intraarterial infusion of a solution of 1,000-mL normal saline, 1,000-U heparin, and 500-mg tolazoline at a rate of 30 mL/h to 60 mL/h.39,40 Currently used vasodilators in angiography suites include intra-arterial nitroglycerin (50-100 mg) or nifedipine (10 mg per os or sublingual).