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

{"article_title":"Guidelines for management of actual or suspected inadvertent intra-arterial injection of sclerosants.","author":"Parsi K, De Maeseneer M, van Rij AM, Rogan C, Bonython W, Devereux JA, Lekich CK, Amos M, Bozkurt AK, Connor DE, Davies AH, Gianesini S, Gibson K, Gloviczki P, Grabs A, Grillo L, Hafner F, Huber D, Iafrati M, Jackson M, Jindal R, Lim A, Lurie F, Marks L, Raymond-Martimbeau P, Paraskevas P, Ramelet AA, Rial R, Roberts S, Simkin C, Thibault PK, Whiteley MS","journal_title":"Phlebology","issn":"1758-1125","isbn":"","publication_date":"2024 Dec","volume":"39","issue":"10","first_page":"683","page_count":"","accession_number":"39046331","doi":"10.1177\/02683555241260926","publisher":"Sage","doctype":"Journal Article","subjects":"Injections, Intra-Arterial adverse effects; Sclerosing Solutions administration & dosage; Sclerosing Solutions adverse effects; Sclerotherapy adverse effects; Humans; Angiography, Digital Subtraction; Ischemia diagnostic imaging; Ischemia etiology; Ischemia therapy; Practice Guidelines as Topic","interest_area":["Cardiology"," Internal Medicine"],"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. 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.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=39046331&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Parsi K, De Maeseneer M, van Rij AM, Rogan C, Bonython W, Devereux JA, Lekich CK, Amos M, Bozkurt AK, Connor DE, Davies AH, Gianesini S, Gibson K, Gloviczki P, Grabs A, Grillo L, Hafner F, Huber D, Iafrati M, Jackson M, Jindal R, Lim A, Lurie F, Marks L, Raymond-Martimbeau P, Paraskevas P, Ramelet AA, Rial R, Roberts S, Simkin C, Thibault PK, Whiteley MS","Journal_Info":"Publisher: Sage Country of Publication: England NLM ID: 9012921 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1758-1125 (Electronic) Linking ISSN: 02683555 NLM ISO Abbreviation: Phlebology Subsets: MEDLINE","Publication_Type":"Journal Article; Practice Guideline; Review","Published_Date":"2024-12-01","Source":"Phlebology [Phlebology] 2024 Dec; Vol. 39 (10), pp. 683-719. Date of Electronic Publication: 2024 Jul 24.","Languages":"English","Electronic_ISSN":"1758-1125","MeSH_Terms":"Injections, Intra-Arterial*\/adverse effects , Sclerosing Solutions*\/administration & dosage , Sclerosing Solutions*\/adverse effects , Sclerotherapy*\/adverse effects, Humans ; Angiography, Digital Subtraction ; Ischemia\/diagnostic imaging ; Ischemia\/etiology ; Ischemia\/therapy ; Practice Guidelines as Topic","Subjects":"Humans, Angiography, Digital Subtraction, Ischemia diagnostic imaging, Ischemia etiology, Ischemia therapy, Practice Guidelines as Topic, Injections, Intra-Arterial adverse effects, Sclerosing Solutions administration & dosage, Sclerosing Solutions adverse effects, Sclerotherapy adverse effects","Title_Abbreviations":"Phlebology","Volume":"39"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"39046331","RelevancyScore":"1001","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"1001.15148925781"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=39046331&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=39046331&authtype=shib&custid=ns346513&group=main&profile=eds"}