the incidence of vascular complications due to drug abuse is at present increasing due to new types of drugs and to the different ways of intake of such substances the vascular complications related to drug abuse may affect venous arterious and lymphatic districts and in particular ischemia following intra arterial injections arterious and venous pseudoaneurysm vasculitis aneurysms aortic dissections abscesses complicated by erosions of vessels arteriovenous fistulas compartment syndrome superficial and deep venous thrombosis septic trombophlebitis puffy hand syndrome the scientific knowledge in this matter is incomplete because of the new pathological cases and the lack of information regarding the efficacy of different treatments the authors report four patients affected by vascular pathologies due to drug abuse in one case a heroin addict has undergone multiple fasciotomies for compartimental syndrome arising because the patient maintained an innatural posture for several hours during an overdose coma in a second case a segmental right subclavear deep venous thrombosis has been treated by pharmacological therapy with satisfactory functional recovery of the arm a third patient has been successfully submitted to intra arterial pharmacological vasodilatation for generalised lower limbs vasospasm caused by drug abuse in the last case the voluntary swallowing of a great dose of cocaine caused the patient s death after multiple ischemic and hemorrhagic cerebral episodes after the description of these cases a review of the recent literature and some observations on this topic are presented a better knowledge of vascular complications due to drug abuse should improve the therapeutical approach of these patients.