van Loghem Jani, Funt David, Pavicic Tatjana, Goldie Kate, Yutskovskaya Yana, Fabi Sabrina, Siebenga Pieter, Thuis Job, Hkeik Joseph, Kadouch Jonathan, Prager Welf, Azib Nabila, Casabona Gabriela, Dayan Steve, Bay Aguilera Shino, Snozzi Philippe, Saeed Peerooz
Falck Clinic, Aesthetic Medicine Centre, Amsterdam, The Netherlands.
Mount Sinai School of Medicine, New York, NY, USA.
J Cosmet Dermatol. 2020 Nov;19(11):2845-2858. doi: 10.1111/jocd.13353. Epub 2020 Mar 17.
Inadvertent intra-arterial injection of dermal fillers including calcium hydroxylapatite (CaHA) can result in serious adverse events including soft tissue necrosis, permanent scarring, visual impairment, and blindness. When intra-arterial injection occurs, immediate action is required for optimal outcomes, but the infrequency of this event means that many physicians may never have experienced this scenario. The aim of this document is to provide evidence-based and expert opinion recommendations for the recognition and management of vascular compromise following inadvertent injection of CaHA.
An international group of experts with experience in injection of CaHA and management of vascular complications was convened to develop a consensus on the optimal management of vascular compromise following intra-arterial CaHA injection. The consensus members were asked to provide preventative advice for the avoidance of intravascular injection and to produce a treatment protocol for acute and delayed presentation. To ensure all relevant treatment options were included, the recommendations were supplemented with a PubMed search of the literature.
For prevention of intra-arterial CaHA injection, consensus members outlined the importance of a thorough knowledge of facial vascular anatomy and patient history, as well as highlighting potential risk zones and optimal injection techniques. Individual sections document how to recognize the symptoms of vascular occlusion leading to vision loss and tissue necrosis as well as detailed treatment protocols for the management of these events. For impending tissue necrosis, recommendations are provided for early and delayed presentations with treatment protocols for acute and follow-up treatment. A separate section details the treatment options for open and closed wounds.
All physicians should be prepared for the eventuality of intra-arterial injection of a dermal filler, despite its rarity. These consensus recommendations combine advice from aesthetic experts with the latest reports from the published literature to provide an up-to-date office-based protocol for the prevention and treatment of complications arising from intra-arterial CaHA injection.
意外动脉内注射包括羟基磷灰石钙（CaHA）在内的真皮填充剂可导致严重不良事件，包括软组织坏死、永久性瘢痕形成、视力损害和失明。当发生动脉内注射时，需要立即采取行动以获得最佳结果，但该事件的发生率较低意味着许多医生可能从未经历过这种情况。本文的目的是为意外注射CaHA后血管受损的识别和处理提供基于证据的专家意见建议。
召集了一组在CaHA注射和血管并发症处理方面有经验的国际专家，就动脉内注射CaHA后血管受损的最佳处理达成共识。要求共识成员提供避免血管内注射的预防性建议，并制定急性和延迟就诊的治疗方案。为确保纳入所有相关治疗选择，通过PubMed检索文献对建议进行了补充。
为预防动脉内注射CaHA，共识成员概述了全面了解面部血管解剖结构和患者病史的重要性，同时强调了潜在风险区域和最佳注射技术。各部分分别阐述了如何识别导致视力丧失和组织坏死的血管阻塞症状，以及这些事件的详细处理方案。对于即将发生的组织坏死，针对早期和延迟就诊提供了建议，并制定了急性治疗和后续治疗的方案。单独的一部分详细介绍了开放性和闭合性伤口的治疗选择。
尽管动脉内注射真皮填充剂的情况罕见，但所有医生都应做好应对准备。这些共识性建议将美学专家的建议与已发表文献中的最新报告相结合，提供了一个最新的基于门诊的方案，用于预防和治疗动脉内注射CaHA引起的并发症。
