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To the Editor: Thank you for letting me respond to Dr. Borenstine's letter.
Intra-arterial injection was postulated rather than arterial spasm because of the rapidity of the reaction along the entire course of the common iliac artery from an injection more distally. Further evidence of retrograde irritation was the observation of involvement of the opposite common iliac artery.
Arterial spasm, such as seen in femoral-artery puncture, causes distal spastic phenomena but is not ordinarily associated with recognizable proximal or contralateral constriction.
As to Dr. Borenstine's second point: sympathetic block by spinal anesthesia did not seem to help our patient, although this was several hours post injury. If we are correct in our assumption that particulate matter was injected intra-arterially, extraluminal injection of an anesthetic agent in the buttock would not be expected to have been of significant therapeutic value.
Animal work on the pathophysiology of intraarterial injection of viscous penicillin
KNOWLES JA. TRANSVERSE MYELITIS AND PENICILLIN-Reply. Am J Dis Child. 1966;112(2):167–168. doi:10.1001/archpedi.1966.02090110110021
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