Abstract

Intra-arterial drug injection is a rare emergency but can occur accidentally by IV drug abusers or iatrogenically in some patients [1]. The accidental injections of some drugs can lead to acute ischemia of the affected limb and digital gangrene [2]. Unintentional intra-arterial injection of drugs either iatrogenic or self-administered, is a source of significant morbidity. Delivery of certain drugs via arterial access can lead to clinically important sequelae, including paresthesias, severe pain, motor dysfunction, compartment syndrome, gangrene, and limb loss [3]. This problem is becoming more common in IV drug addicts.

Drug addicted patients tend to have fibrotic thrombosed peripheral veins due to repetitive injections of highly irritating drugs [4]. We have seen many drug addicted patients with compromised superficial peripheral venous system in both upper and lower limbs in which obtaining a peripheral line is too challenging and hence can lead to accidental intraarterial injection of drugs. We report a case of ruptured axillary artery secondary due to selfinflicted injury by IV tramadol injection in a young tramadol addicted male which was managed successfully by exploration and repair with vein graft.