Ray K, Savaser D, Huang E, et al.
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc. Date of publication 2021 Jul 1;volume 48(3):255-261.
1. Undersea Hyperb Med. 2021 Third Quarter;48(3):255-261.
Hyperbaric oxygen therapy and fluorescence angiography in arterial insufficiency
secondary to injection of crushed hydromorphone.
Ray K(1), Savaser D(2), Huang E(2).
Author information:
(1)Department of Hyperbaric Medicine, Louisiana State University, New Orleans,
Louisiana U.S.
(2)Hyperbaric Medicine and Chronic Wound Clinic, Legacy Emanuel Medical Center,
Portland, Oregon U.S.
INTRODUCTION: Foreign body emboli can lead to acute arterial insufficiency. We
present a case report of upper extremity arterial insufficiency in an
intravenous (IV) drug user secondary to intra-arterial injection of crushed
tablet particles successfully treated with hyperbaric oxygen (HBO2) therapy.
CASE: A 37-year-old right-hand-dominant male developed pain and swelling of the
left hand after attempting to inject crushed hydromorphone tablets into his
venous circulation. Angiography revealed incomplete distal filling of the proper
digital arteries, princeps pollicis, and radialis indicis branches of the left
hand. The patient was treated with HBO2 for acute arterial insufficiency,
secondary to these findings. Fluorescence angiography was performed prior to,
during and after completion of HBO2, which showed improved perfusion of the hand
upon completion of serial imaging. The patient underwent subsequent partial
amputation of the left second digit and removal of the thenar and third finger
pads.
DISCUSSION: Much of the literature on treatment of arterial insufficiency with
HBO2 are in relation to chronic problem wounds. However, there is limited data
on adjunctive treatment with HBO2 for foreign body embolism. Fluorescence
angiography and clinical exam were used to track tissue perfusion and
progression throughout course of therapy with HBO2.
CONCLUSION: Acute arterial insufficiency induced by foreign body embolism was
successfully treated with HBO2 and provided increased tissue salvage of the
patient's hand. The use of fluorescence angiography as a secondary measure of
perfusion can provide additional insight regarding qualitative tissue
oxygenation and may be a viable tool to track patient progress during HBO2
treatment.
Copyright© Undersea and Hyperbaric Medical Society.
PMID: 34390630 [Indexed for MEDLINE]
Conflict of interest statement: The authors of this paper declare no conflicts
of interest exist with this submission.
