{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:05:05Z","timestamp":1783343105095,"version":"3.54.6"},"reference-count":18,"publisher":"Termedia Sp. z.o.o.","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Med Sci Atheroscler Dis"],"abstract":"<jats:p>Acral ischaemia and necrosis are rare but severe complications of high-dose or prolonged vasopressor therapy in critically ill patients. Although these agents are life-saving in distributive shock, intense a-adrenergic vasoconstriction, microcirculatory failure, and coagulopathy can converge to cause irreversible digital or limb necrosis, often requiring amputation and sometimes leading to medicolegal disputes. We report two cases of vasopressor-associated acral necrosis. These cases illustrate the multifactorial pathogenesis of vasopressor-induced acral necrosis, in which profound vasoconstriction, endothelial injury, microthrombosis, and the severity of underlying shock lead to distal tissue loss despite intact large-vessel pulses. Consequences include prolonged hospitalisation, the need for staged surgical or reconstructive procedures, long-term functional deficits, and substantial psychosocial burden. The dramatic nature of limb loss after life-saving therapy frequently triggers medicolegal scrutiny regarding dosing, monitoring, and documentation. Awareness of this uncommon but devastating complication is essential.<\/jats:p>","DOI":"10.5114\/amsad\/216338","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T07:08:26Z","timestamp":1776064106000},"page":"38-44","source":"Crossref","is-referenced-by-count":1,"title":["Life-saving but limb-threatening: vasopressor-induced acral ischaemia and necrosis \u2013 two cases and review \nof the literature"],"prefix":"10.5114","volume":"11","author":[{"given":"Vasileios","family":"Leivaditis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesk","family":"Mulita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Nikolakopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chrysa","family":"Andrikopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Tasios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Liolis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Antzoulas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Antzoulas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Litsas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis Dimitrios","family":"Papadopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Theofanis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Boucharas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Panagiotopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamas","family":"B\u00fcki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred","family":"Dahm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyros","family":"Papadoulas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3061","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref-1754628","doi-asserted-by":"crossref","unstructured":"Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47: 1181-247.","DOI":"10.1007\/s00134-021-06506-y"},{"key":"ref-1754629","doi-asserted-by":"crossref","unstructured":"Derry KH, Rocks MC, Izard P, Nicholas RS, Sommer PM, Hacquebord JH. Limb necrosis in the setting of vasopressor use. Am J Crit Care 2024; 33: 226-33.","DOI":"10.4037\/ajcc2024171"},{"key":"ref-1754630","doi-asserted-by":"crossref","unstructured":"Daroca-P\u00e9rez R, Carrascosa MF. Digital necrosis: a\u00a0potential risk of high-dose norepinephrine. Ther Adv Drug Saf 2017; 8: 259-61.","DOI":"10.1177\/2042098617712669"},{"key":"ref-1754631","doi-asserted-by":"crossref","unstructured":"Shenoy R, Agarwal N, Goneppanavar U, Shenoy A, Sharma A. Symmetrical peripheral gangrene-a\u00a0case report and brief review. 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Septic shock following prostate biopsy: aggressive limb salvage for extremities after pressor-induced ischemic gangrene. Plast Reconstr Surg Glob Open 2017; 5: e1430.","DOI":"10.1097\/GOX.0000000000001430"},{"key":"ref-1754640","doi-asserted-by":"crossref","unstructured":"Deldar R, Abu El Hawa AA, Haffner ZK, et al. Achieving functional outcomes after surgical management of catastrophic vasopressor-induced limb ischemia. Plast Reconstr Surg Glob Open 2022; 10: e4175.","DOI":"10.1097\/GOX.0000000000004175"},{"key":"ref-1754641","doi-asserted-by":"crossref","unstructured":"Henn MC, Hathaway BA, Lipira AB. Reconstructive surgical management of vasopressor-ischemia related distal extremity loss. J Orthop Case Rep 2025; 15: 45-51.","DOI":"10.13107\/jocr.2025.v15.i04.5440"},{"key":"ref-1754642","doi-asserted-by":"crossref","unstructured":"O\u2019Dell BL, Kochhar K, Johnson A. Vasopressor-induced peripheral gangrene secondary to COVID-19: a\u00a0case report. 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