Treatment of bilateral hand frostbite using transcatheter arterial thrombolysis after papaverine infusion.

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.