Biegeleisen K, Neilsen R D, O'Shaughnessy A
J Dermatol Surg Oncol. 1993 Oct;19(10):953-8. doi: 10.1111/j.1524-4725.1993.tb00984.x.
Intra-arterial injection is the most dreaded complication of sclerotherapy of varicose veins. The medical literature does not contain enough data to enable one to formulate a definitive strategy for either the prevention or treatment of this complication.
Seven cases of intra-arterial injection are presented. The causes of these accidents, the recognition of the signs that intra-arterial injection has occurred, and the treatment of these cases are discussed.
Intra-arterial injection occurs in a variety of different settings. The signs that an intra-arterial injection has taken place are variable, but in some cases there are no signs until irreversible tissue damage has already set in. Treatment protocols are based mainly on anticoagulation with heparin, which is administered both intravenously and subcutaneously.
Heparin, whether administered continuously by the intravenous route or subcutaneously (twice daily), makes affected areas look and feel better, but there is no proof that it alters the final outcome with respect to tissue necrosis. In agreement with previous authors, we believe that there is a beneficial effect. Coumadin, on the other hand, appears to be completely ineffective.
Protocols employing heparin should be considered in cases of suspected intra-arterial injection. The length of time heparin should be continued is uncertain. The best "treatment" is prevention.
动脉内注射是静脉曲张硬化治疗最可怕的并发症。医学文献中没有足够的数据使人们能够制定出预防或治疗这种并发症的明确策略。
介绍7例动脉内注射病例。讨论这些事故的原因、动脉内注射发生的迹象的识别以及这些病例的治疗。
动脉内注射发生在各种不同的情况下。动脉内注射发生的迹象各不相同，但在某些情况下，直到不可逆转的组织损伤已经发生才会出现迹象。治疗方案主要基于肝素抗凝，通过静脉和皮下给药。
肝素，无论是通过静脉途径持续给药还是皮下给药（每日两次），都会使受影响区域的外观和感觉更好，但没有证据表明它会改变组织坏死的最终结果。与之前的作者一致，我们认为有有益的效果。另一方面，香豆素似乎完全无效。
对于疑似动脉内注射的病例，应考虑采用肝素的治疗方案。肝素应持续使用的时间不确定。最好的“治疗”是预防。
