Abstract
Standard therapy for frostbite has been unaltered for more than 20 years. Recently there have been reports of improved outcomes with the addition of a vasodilator to intra-arterial thrombolytic therapy. We report the case of severe frostbite of the hands successfully treated with transcatheter intra-arterial tPA after papaverine infusion in a 37-year-old man. Upper extremity and hand angiography within 16 h of the insult showed thrombotic occlusive disease and vasospasm. Intra-arterial catheters were placed in the brachial arteries and a papaverine infusion was initiated, followed by intra-arterial tPA thrombolysis. Follow-up examination at 4 months revealed full hand function and complete resolution of symptoms.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Twomey JA, Peltier GL, Zera RT (2005) An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite. J Trauma 59:1350–1354; discussion 1354–1355
Bruen KJ, Ballard JR, Morris SE, Cochran A, Edelman LS, Saffle JR (2007) Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg 142:546–551; discussion 551–543
Edmonson G, Bretzman P, Mohr D, Ahernholtz D (2008) Intraarterial thrombolytic therapy for limb salvage in severe frostbite. J Vasc Interv Radiol 19 (Suppl S):abstract 52
Murphy JV, Banwell PE, Roberts AH, McGrouther DA (2000) Frostbite: pathogenesis and treatment. J Trauma 48:171–178
Koljonen V, Andersson K, Mikkonen K, Vuola J (2004) Frostbite injuries treated in the Helsinki area from 1995 to 2002. J Trauma 57:1315–1320
Salimi Z, Wolverson MK, Herbold DR, Vas W, Salimi A (1987) Treatment of frostbite with i.v. streptokinase: an experimental study in rabbits. AJR 149:773–776
Daum PS, Bowers WD Jr, Tejada J, Morehouse D, Hamlet MP (1989) An evaluation of the ability of the peripheral vasodilator buflomedil to improve vascular patency after acute frostbite. Cryobiology 26:85–92
Barat AK, Puri HC, Ray N (1978) Cold injuries in Kashmir, December 1971. Ann Roy Coll Surg Engl 60:332–335
Snider RL, Porter JM (1975) Treatment of experimental frostbite with intra-arterial sympathetic blocking drugs. Surgery 77:557–561
Yeager RA, Campion TW, Kerr JC, Hobson RW 2nd, Lynch TG (1983) Treatment of frostbite with intra-arterial prostaglandin E1. Am Surg 49:665–667
Ouriel K, Kandarpa K (2004) Safety of thrombolytic therapy with urokinase or recombinant tissue plasminogen activator for peripheral arterial occlusion: a comprehensive compilation of published work. J Endovasc Ther 11:436–446
Acknowledgments
We thank Charles W. Johnson for assistance with manuscript preparation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Saemi, A.M., Johnson, J.M. & Morris, C.S. Treatment of Bilateral Hand Frostbite Using Transcatheter Arterial Thrombolysis After Papaverine Infusion. Cardiovasc Intervent Radiol 32, 1280–1283 (2009). https://doi.org/10.1007/s00270-009-9584-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-009-9584-9