Parsi, Kurosh; De Maeseneer, Marianne; van Rij, Andre M; Rogan, Christopher; Bonython, Wendy; Devereux, John A; Lekich, Christopher K; Amos, Michael; Bozkurt, Ahmet Kursat; Connor, David E; Davies, Alun H; Gianesini, Sergio; Gibson, Kathleen; Gloviczki, Peter; Grabs, Anthony; Grillo, Lorena; Hafner, Franz; Huber, David; Iafrati, Mark; Jackson, Mark; ... (2024). Guidelines for management of actual or suspected inadvertent intra-arterial injection of sclerosants. (In Press). Phlebology : the journal of venous disease, p. 2683555241260926. Sage 10.1177/02683555241260926
Full text not available from this repository.BACKGROUND
Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity.
OBJECTIVES
To provide recommendations for diagnosis and immediate management of an unintentional intra-arterial injection of sclerosing agents.
METHODS
An international and multidisciplinary expert panel representing the endorsing societies and relevant specialities reviewed the published biomedical, scientific and legal literature and developed the consensus-based recommendations.
RESULTS
Actual and suspected cases of an intra-arterial sclerosant injection should be immediately transferred to a facility with a vascular/interventional unit. Digital Subtraction Angiography (DSA) is the key investigation to confirm the diagnosis and help select the appropriate intra-arterial therapy for tissue ischaemia. Emergency endovascular intervention will be required to manage the risk of major limb ischaemia. This includes intra-arterial administration of vasodilators to reduce vasospasm, and anticoagulants and thrombolytic agents to mitigate thrombosis. Mechanical thrombectomy, other endovascular interventions and even open surgery may be required. Lumbar sympathetic block may be considered but has a high risk of bleeding. Systemic anti-inflammatory agents, anticoagulants, and platelet inhibitors and modifiers would complement the intra-arterial endovascular procedures. For risk of minor ischaemia, systemic oral anti-inflammatory agents, anticoagulants, vasodilators and antiplatelet treatments are recommended.
CONCLUSION
Inadvertent intra-arterial injection is an adverse event of both ultrasound-guided and direct vision sclerotherapy. Medical practitioners performing sclerotherapy must ensure completion of a course of formal training (specialty or subspecialty training, or equivalent recognition) in the management of venous and lymphatic disorders (phlebology), and be personally proficient in the use of duplex ultrasound in vascular (both arterial and venous) applications, to diagnose and provide image guidance to venous procedure. Expertise in diagnosis and immediate management of an intra-arterial injection is essential for all practitioners performing sclerotherapy.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Dermatology |
UniBE Contributor: |
Ramelet, Albert-Adrien |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1758-1125 |
Publisher: |
Sage |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
25 Jul 2024 08:03 |
Last Modified: |
26 Jul 2024 10:45 |
Publisher DOI: |
10.1177/02683555241260926 |
PubMed ID: |
39046331 |
Uncontrolled Keywords: |
Sclerosants intra-arterial injection necrosis practice guidelines sclerotherapy |
URI: |
https://boris.unibe.ch/id/eprint/199185 |
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