VCOM Louisiana Research Day Program Book 2024

Case Studies

Michael Chammany, OMS-III; Tanya Kumar, OMS-III; Mohammad-Hesam Akbarian-Tefaghi, MD VCOM; Willis-Knighton Health System 51 DEVELOPMENT AND COMPLICATIONS OF VASOPRESSOR-INDUCED ACUTE LIMB ISCHEMIA FOLLOWING MANAGEMENT OF UROSEPSIS: A CASE REPORT

Background: Patients in septic shock (hypotension not responsive to resuscitation fluids) are frequently in need of vasopressors to maintain perfusion. Vasopressor use can rarely cause non-occlusive peripheral limb ischemia leading to necrosis necessitating amputation. We present a case of a 70-year-old woman with urinary sepsis secondary to right ureteral calculus and right hydronephrosis. Levophed was administered prior to transfer to our hospital. She was transitioned to Vasopressin on admission to maintain a MAP above 70 mmHg. Two days post-admission, the patient developed iatrogenic dry gangrene, initially affecting the fingers bilaterally. Vasopressors were tapered in response to evident ischemia, and antiplatelet medications were discontinued in light of her thrombocytopenia. Despite these interventions, dry gangrene progressed into the right and left hands, the digits of the right foot, and up to the midfoot of the left foot. This eventually resulted in amputations of the right lower extremity, left lower extremity, and left upper extremity. Though the patient’s ischemia ceased to progress following the amputations, the comorbidities of her complication led to an increased hospital stay and eventual need of placement into a nursing home capable of long-term advanced care.

Methods: Search terms used included Vasopressor-Induced Microvascular Thrombosis, Vasopressor-Mediated Digital Ischemia, and Vasopressor-Induced Acute Limb Ischemia. Conclusions: Our aim in examining the clinical presentation and treatment of this patient is to enhance clinical vigilance in diagnosing vasopressor-induced acute limb ischemia (VIALI). The existing guidelines on managing this condition remain limited, yet various studies have illuminated strategies to mitigate vasopressor-induced necrosis. For instance, recent papers such as ‘Management of Vasopressor-Induced Acute Limb Ischemia (VIALI) in Septic Shock’ by Attallah et al. (2022) and ‘Vasopressor-Induced Digital Ischemia’ by Jesani et al. (2021) have meticulously documented cases of VIALI, each shedding light on different factors that may contribute to this severe complication. Our discussion seeks to delineate both commonalities and disparities in care, with the ultimate goal of contributing to the establishment of a more encompassing protocol for physicians handling vasopressor induced acute limb ischemia. Furthermore, we aim to advocate for integrating osteopathic considerations in the care of ischemic patients, as this approach holds promise in optimizing

lymphatic flow and alleviating the ischemic burden on affected limbs.

73 2024 Via Research Recognition Day