Management of a patient with unintended intravenous dihydroergotamine infusion extravasation causing brachial artery vasospasm

We present a patient being treated with intravenous dihydroergotamine (DHE) complicated by brachial artery vasospasm secondary to extravasation of DHE from an infiltrated peripheral intravenous catheter. She subsequently developed symptomatic vasospasm of the brachial artery, which ultimately required surgical intervention. Severe vasospasm remains a rare but serious risk of intravenous DHE extravasation, but there is currently limited data on proper management of this complication. This case report documents our management that led to full recovery of the patient. We recommend the use of reliable catheters for DHE infusions and prompt vascular surgery consult if there is suspicion for unintended extravasation.