|
|
||||
|
Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
||||
|
ISSN 1681-715X |
||||
|
||||
|
- |
||||
|
Brief Communication |
||||
|
- |
||||
|
Volume 23 |
January - March 2007 |
Number 1 |
||
|
|
||||
|
|
||||
|
|
||||
|
Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
||||
|
ISSN 1681-715X |
||||
|
||||
|
- |
||||
|
Brief Communication |
||||
|
- |
||||
|
Volume 23 |
January - March 2007 |
Number 1 |
||
|
|
||||
|
|
||||
Brief report in vascular medicine Ergotamine-induced
acute vascular insufficiency of the lower limbsJalal Vahedian1, Abdollah Panahipour2
1. Dr. Jalal Vahedian
Associate Professor of General and Vascular Surgery,
Department of Cardiovascular Surgery,
2. Dr. Abdollah Panahipour
Associate Professor of Anesthesiology,
Department of Anesthesio,1-2: Rajaie Hospital and Research Center,
Adjacent to Mellat Park, Vali-Asr Avenue,
Post Code: 1996911151,
Tehran, Iran.Correspondence:
Dr. Jalal Vahedian
E-Mail: jalvahedian@yahoo.com* Received for publication: June 24, 2006
* Accepted: October 26, 2006
A 52-years-old female presented with acute severe claudication of lower extremities. Clinical examination and Doppler sonography revealed weakened pulsation of femoral arteries, but no detectable pulsation in both popliteal arteries and at more peripheral sites. Emergency multislice computed tomography (MSCT) angiography, using intravenous injection of non-ionic medium, demonstrated the morphology of bilateral and symmetrical smooth tapered narrowing of iliac and femoro-popliteal arteries. The patient suffered from recurrent erythema nodosum in her legs for 6 months. The patient’s medical history was typical for a person who suffers migraine headaches. During the previous two years, she received analgesic treatment with ergotamine tartrate. She also received propranolol 20 mg three times a day for 15 years too.
Given this history and our evaluation of the angiographic images, we presumed ergotamine-induced vasospasm as the most likely diagnosis. Therefore, we favored an approach with the following treatment aspects:
1. Cessation of treatment with ergotamine-containing drugs.
2. Treatment with heparin and antiplatelet agents as prophylaxis to prevent secondary thrombosis related to stasis.
3. Management of headache using safer medication. With this therapeutic concept, symptoms indicating arterial ischemia soon disappeared.. After few days, the patient had no complains and revealed normal femoral and distal pulses. This case shows that the importance of a careful medication history cannot be over-emphasised. Furthermore, ergotamine agents, now largely superseded by newer medications, should be prescribed with caution.
REFERENCES
1- Christopoulos S, Minuk J, Assimakopoulos P, Kahn SR. Clinical picture: Epidural lipomatosis. Lancet 2001;358(9297):1982.
2- Halloul Z, Meyer F, Lippert H, Buerger T. Ergotamine-induced acute vascular insufficiency of the lower limb-a case report. Angiology 2001;52(3):217-21.
3- Zavaleta EG, Fernandez BB, Grove MK, Kaye MD. St. Anthony’s fire (ergotamine induced leg ischemia)—a case report and review of the literature. Angiology 2001;52(5):349-56.
HOME | SEARCH | CURRENT ISSUE | PAST ISSUES
Professional
Medical Publications
Room No. 522, 5th Floor, Panorama Centre
Building No. 2, P.O. Box 8766, Saddar, Karachi - Pakistan.
Phones : 5688791, 5689285 Fax : 5689860
pjms@pjms.com.pk
