Local α-receptor antagonists as a targeted therapeutic approach in patients with vasopressor-induced symmetrical peripheral gangrene

Objectives: Symmetrical peripheral gangrene (SPG) is a rare condition characterized by symmetrical gangrene affecting the acral regions of two or more extremities, without the presence of major vessel obstruction. The precise pathophysiology of SPG is unclear, but it is believed to involve various biochemical pathways and is often associated with vasopressor therapy. Despite various therapeutic attempts, there is no established standard treatment for SPG. Methods: This study evaluated the efficacy of locally administered phentolamine, an alpha-receptor antagonist, in four critically ill patients undergoing catecholamine therapy and presenting with SPG. Tissue perfusion was assessed using clinical observation and indocyanine green-assisted laser angiography before and after phentolamine administration. Results: All four patients demonstrated immediate improvement in tissue perfusion following phentolamine application, as evidenced by angiography. No amputations were necessary. The patients' clinical outcomes suggest that phentolamine effectively counteracts vasopressor-induced ischemia. Conclusions: Phentolamine offers a targeted therapeutic approach for vasopressor-induced SPG by mitigating vasoconstriction without systemic side effects. Its incorporation into clinical practice requires further validation to optimize its application and efficacy.