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

Autor:	Parsi K; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Australasian College of Phlebology (ACP), Chatswood, NSW, Australia.; Department of Dermatology, St Vincent's Hospital, Sydney, NSW, Australia.; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.; Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia., De Maeseneer M; Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands., van Rij AM; Australasian College of Phlebology (ACP), Chatswood, NSW, Australia.; Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand., Rogan C; Interventional Radiology Society of Australasia (IRSA), Camperdown, NSW, Australia.; Department of Medical Imaging, Sydney Adventist Hospital, Sydney, NSW, Australia.; Macquarie University Hospital, Sydney, NSW, Australia., Bonython W; Faculty of Law, Bond University, Gold Coast, QLD, Australia., Devereux JA; University of Queensland Law School, University of Queensland, Saint Lucia, QLD, Australia., Lekich CK; Miami Private Hospital, Gold Coast, QLD, Australia., Amos M; Department of Anaesthesiology, Concord Hospital, Sydney, NSW, Australia., Bozkurt AK; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Department of Cardiovascular Surgery, Istanbul University, Istanbul, Turkie., Connor DE; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.; Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia., Davies AH; European College of Phlebology, Rotterdam, The Netherlands.; Vascular Surgery, Imperial College London, Charing Cross and St Mary's Hospital, London, UK., Gianesini S; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Vascular Surgery, University of Ferrara, Ferrara, Italy., Gibson K; Lake Washington Vascular Surgeons, Bellevue, WA, USA., Gloviczki P; Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA., Grabs A; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.; Department of Vascular Surgery, St Vincent's Hospital, Sydney, NSW, Australia., Grillo L; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Vascular Surgery, University of Medical Sciences (UCIMED), San Jose, Costa Rica., Hafner F; Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria., Huber D; Art of Vein Care, Wollongong, NSW, Australia., Iafrati M; American Venous Forum (AVF), East Dundee, IL, USA.; Vanderbilt University Medical Center, Vanderbuilt University, Nashville, TN, USA., Jackson M; Australian and New Zealand Society for Vascular Surgery(ANZSVS), Melbourne, VIC, Australia.; Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia.; School of Medicine, Griffith University, Gold Coast, QLD, Australia., Jindal R; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Vascular Surgery, Fortis Hospital, Mohali, India., Lim A; Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia., Lurie F; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Jobst Vascular Institute, Toledo, OH, USA.; Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA., Marks L; Australasian College of Phlebology (ACP), Chatswood, NSW, Australia.; Brighton Day Surgery, Adelaide, SA, Australia., Raymond-Martimbeau P; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Dallas Non-Invasive Vascular Laboratory and Vein Institute of Texas, Dallas, TX, USA., Paraskevas P; Paras Clinic, Melbourne, VIC, Australia., Ramelet AA; Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland., Rial R; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Vascular and Endovascular Surgery, University Hospital HM Madrid, Torrelodones, Spain., Roberts S; Victoria Vein Clinic, Melbourne, VIC, Australia., Simkin C; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Clínica Simkin, Buenos Aires, Argentina., Thibault PK; International Union of Phlebology (UIP), Chatswood, NSW, Australia.; Australasian College of Phlebology (ACP), Chatswood, NSW, Australia.; Central Vein and Cosmetic Medical Centre, Newcastle, NSW, Australia., Whiteley MS; The College of Phlebology, Guildford, UK.; The Whiteley Clinic, Guildford, UK.
Jazyk:	angličtina
Zdroj:	Phlebology [Phlebology] 2024 Dec; Vol. 39 (10), pp. 683-719. Date of Electronic Publication: 2024 Jul 24.
DOI:	10.1177/02683555241260926
Abstrakt:	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. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KG has declared consultancy for Medtronic, Boston Scientific, Gore, Philips and Koya, research support from Medtronic, Boston Scientific, Gore and Philips and speaker for Medtronic, Boston Scientific, Philips and Janssen. All other authors have no competing interests or conflicts of interest to declare.
Databáze:	MEDLINE
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