Guidelines for management of actual or suspected inadvertent intra-arterial injection of sclerosants.

Phlebology Pub Date : 2024-12-01 Epub Date: 2024-07-24 DOI:10.1177/02683555241260926
Kurosh Parsi, Marianne De Maeseneer, Andre M van Rij, Christopher Rogan, Wendy Bonython, John A Devereux, Christopher K Lekich, Michael Amos, Ahmet Kursat Bozkurt, David E Connor, Alun H Davies, Sergio Gianesini, Kathleen Gibson, Peter Gloviczki, Anthony Grabs, Lorena Grillo, Franz Hafner, David Huber, Mark Iafrati, Mark Jackson, Ravul Jindal, Adrian Lim, Fedor Lurie, Lisa Marks, Pauline Raymond-Martimbeau, Peter Paraskevas, Albert-Adrien Ramelet, Rodrigo Rial, Stefania Roberts, Carlos Simkin, Paul K Thibault, Mark S Whiteley
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引用次数: 0

Abstract

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.

实际或怀疑无意中动脉内注射硬化剂的处理指南。
背景:无意中动脉内注射硬化剂是超声引导和直视硬化剂治疗中不常见的不良事件。这种并发症可导致严重的组织或肢体损失以及长期的严重发病率:为硬化剂意外动脉内注射的诊断和即时处理提供建议:方法:由一个国际性多学科专家小组代表认可学会和相关专科,对已发表的生物医学、科学和法律文献进行了审查,并制定了基于共识的建议:结果:动脉内注射硬化剂的实际病例和疑似病例应立即转送至设有血管/介入科的医疗机构。数字减影血管造影术(DSA)是确诊的关键检查手段,有助于选择适当的动脉内疗法治疗组织缺血。需要进行紧急血管内介入治疗,以控制肢体大面积缺血的风险。这包括动脉内注射血管扩张剂以减轻血管痉挛,以及注射抗凝剂和溶栓剂以减轻血栓形成。可能需要进行机械性血栓切除术、其他血管内介入治疗,甚至开刀手术。可以考虑腰交感神经阻滞,但出血风险很高。全身用抗炎药、抗凝药、血小板抑制剂和调节剂将对动脉内血管手术起到补充作用。对于轻微缺血的风险,建议使用全身口服消炎药、抗凝药、血管扩张剂和抗血小板治疗:结论:无意中进行动脉内注射是超声引导和直视硬化剂治疗的不良事件。进行硬化剂注射治疗的医疗从业人员必须确保完成正规的静脉和淋巴疾病治疗(静脉学)培训课程(专科或亚专科培训,或同等认可),并亲自熟练掌握在血管(动脉和静脉)应用中使用双工超声波,为静脉手术提供诊断和图像指导。所有进行硬化剂注射的从业人员都必须具备动脉内注射诊断和即时处理的专业知识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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