Evaluation and Management of Peripheral
Annotation for Point O
Spasm of a peripheral artery in an injured extremity in a young patient is a common finding on imaging, whether or not the artery has been injured. If distal flow to the hand or foot is intact, observation with warming of the affected part of the extremity is appropriate. Before arterial spasm is thought to be the cause of an ischemic hand or foot, distal in situ thrombosis, distal embolism, or the presence of an advanced compartment syndrome must be ruled out.58 This mandates a repeat arteriographic study or emergent measurement of compartment pressures in both the proximal and distal limb. Severe limb-threatening arterial spasm has been treated with a proximal intra-arterial bolus injection of papaverine 60 mg followed by an infusion of 30 mg/h to 60 mg/h in the past.59 Another option used on rare occasions has been a proximal intra-arterial infusion of a solution of 1,000 mL normal saline; 1,000 units heparin; and 500 mg tolazoline at a rate of 30 mL/h to 60 mL/h.60,61 Currently used vasodilators in angiography suites include intra-arterial nitroglycerin (50–100 mg) or nifedipine (10 mg per os or sublingual).