Introduction to the management of intravascular filler injection, including support for Intra-Vascular Combination Management (IVCM)
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Keywords
arterial occlusion, mechanical thrombolysis, blindness, embolism, reperfusion, dermal fillers adverse effects
Abstract
Background: dermal filler popularity comes with an increased risk of adverse events including blindness and death, through inadvertent intravascular injections. Existing treatment modalities are not as reliable as we would like them to be. Aim: to explore existing preventative measures and treatments for intravascular obstruction and to define, support and propose a definitive treatment that injecting practitioners can rely on. Method: a review of the existing evidence was performed taking into consideration the authors’ experience to provide a summarised suggested protocol for the prevention and management of intravascular filler injections. Results: preventative steps, in room management and referral instructions are provided for practitioners along with a description of the supported neurovascular management. Conclusions: given the evidence of existing treatments for the management of strokes, arterial occlusion, combined filler dissolution and intravascular thrombolysis in animals, emboli and filler, there exists sufficient evidence to support the use of intravascular thrombolytics and hyaluronidase in combination with mechanical thrombectomy to treat intravascular fillers and their accompanying thrombi and emboli.
References
2. Ali-Ahmed F, Federspiel JJ, Liang L, et al. Intravenous Tissue Plasminogen Activator in Stroke Mimics. Circ Cardiovasc Qual Outcomes. 2019; 12(8):e005609.
3. Salinas-Alvarez Y, Welsh EC, Soto-Dominguez, et al. Hyaluronic Acid Embolism Treated with Subcutaneous High and Low Hyaluronidase Doses: Efficacy and Surrounding Tissue Effect. Plast Reconstr Surg. 2021; 148(6):1281-1288.
4. Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016; 15(11):1138-47.
5. Chang SH, Yousefi S, Qin J, et al. External Compression Versus Intravascular Injection: A Mechanistic Animal Model of Filler-Induced Tissue Ischemia. Ophthalmic Plast Reconstr Surg. 2016; 32(4):261-6.
6. Chen VHE, Lee GKH, Tan CH, et al. Intra-Arterial Adjunctive Medications for Acute Ischemic Stroke During Mechanical Thrombectomy: A Meta-Analysis. Stroke. 2021; 52(4):1192-1202.
7. Chuchvara N, Alamgir M, John AM, Rao B. Dermal Filler- Induced Vascular Occlusion Successfully Treated with Tadalafil, Hyaluronidase and Aspirin. Dermatol Surg. 2021; 47(8):1160-1162.
8. Farahani A, Mosahebu A, Zargaran D. A Scooping Review of Hyaluronidase use in Managing the Complications of Aesthetic Interventions. Aesth Plast Surg. 2024; 48:1193-1209.
9. Hayreh SS, Zimmerman MB, Kimura A, Sanon A. Central retinal artery occlusion. Retinal survival time. Exp Eye Res. 2004; 78(3):723-736.
10. Health Quality Ontario. Mechanical Thrombectomy in Patients With Acute Ischemic Stroke: A Health Technology Assessment. Ont Health Technol Assess Ser. 2016; 16(4):1-79.
11. Kim YK, Jung C, Woo SJ, Park KH. Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion. J Korean Med Sci. 2015; 30(12):1847-1855.
12. Lee SH, Gil YC, Choi YJ, Tansatit T, Kim HJ, Hu KS. Topographic anatomy of the superior labial artery for dermal filler injection. Plast Reconstr Surg. 2015; 135(2):445-450.
13. Lima VGF, Regattieri NAT, Pompeu MF, Costa IMC. External vascular compression by hyaluronic acid filler documented with high-frequency ultrasound. J Cosmet Dermatol. 2019; 18(6):1629-1631.
14. Loh KTD, Chua JJ, Lee HM, et al. Prevention and Management of Vision Loss Relating to Facial Filler Injections. Singapore Med J. 2016; 57(8):438- 443.
15. Madala S, Li J, Gluckstein J, Zhang-Nunes S. Management of visual complications of dermal filler injections. Plast Aesthet Res. 2024; 11:10.
16. Middleton EO. Evidence-based clinical guide for the management of peripheral vascular occlusion with hyaluronic acid, report of 6 successful cases. Advances in Oral and Maxillofacial Surgery. 2022; 8(1):1-4.
17. Murray G, Convery C, Walker L, Davies E. Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion. J Clin Aesthet Dermatol. 2021; 14(5):E61-E69.
18. Nguyen HH, Tran HTT, Duong QH, Nguyen MD, Dao HX, Le DT. Significant Vision Recovery from Filler-Induced Complete Blindness with Combined Intra-Arterial Injection of Hyaluronidase and Thrombolytic Agents. Aesthetic Plast Surg. 2022; 46(2):907-911.
19. Oh BL, Jung C, Park KH, Hong YJ, Woo SJ. Therapeutic Intra-arterial Hyaluronidase Infusion for Ophthalmic Artery Occlusion Following Cosmetic Facial Filler (Hyaluronic Acid) Injection. Neuroophthalmology. 2014; 38(1):39-43.
20. Ontario Health. Mechanical Thrombectomy for Acute and Subacute Blocked Arteries and Veins in the Lower Limbs: A Health Technology Assessment. Ont Health Technol Assess Ser. 2023; 23(1):1-244.
21. Page PS, Khattar NK, White AC, et al. Intra-Arterial Thrombolysis for Acute Central Retinal Artery Occlusion: A Systematic Review and Meta-Analysis. Front Neurol. 2018; 9:76.
22. Paolini SL, Kenmuir CL. Thrombolytic Treatment of Central Retinal Artery Occlusion (CRAO). J Neurol Neurosci. 2016; 6(2):12.
23. Renú A, Millán M, San Román L, et al. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke. JAMA. 2022; 327(9):826-835.
24. Sito G, Manzoni V, Sommariva R. Vascular Complications after Facial Filler Injection: A Literature Review and Meta-analysis. J Clin Aesthet Dermatol. 2019; 12(6):E65-E72.
25. Soares DJ, Hynes SD, Yi CH, Shah-Desai S, Irving SC. Cosmetic Filler - Induced Vascular Occlusion: A Rising Threat Presenting to Emergency Departments. Ann Emerg Med. 2024; 83(1):59-67.
26. Baley-Spindel I, Villaseñor-Villalpando E, Márquez-Espriella C, Rivera-Salgado MI, Dávila-Diaz R. Perivascular Hyaluronidase with Alteplase as Treatment for Hyaluronic Acid Thrombosis. Aesthet Surg J. 2020; 40(5):551-559.
27. Tsai FY, Kostanian V, Rivera M, Lee KW, Chen CC, Nguyen TH. Cerebral venous congestion as indication for thrombolytic treatment. Cardiovasc Intervent Radiol. 2007; 30(4):675–687.
28. Turk AS, Frei D, Fiorella D, et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg. 2014; 6(4):260-4.
29. Xu X, Shao X, Cao J, Huang X, Li L. Contact aspiration and stent retriever versus stent retriever alone following mechanical thrombectomy for patients of acute ischemic stroke: A recanalization success analysis. Clinics (Sao Paulo). 2023; 78:100262.
30. Zhang LX, Lai LY, Zhou GW, et al. Evaluation of Intraarterial Thrombolysis in Treatment of Cosmetic Facial Filler-Related Ophthalmic Artery Occlusion. Plast Reconstr Surg. 2020; 145(1):42e-50e.
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Reza Mia, Private medical practice, Anti-aging Art
Medical Doctor MBBCh (WITS) 2006 | MBA Liverpool | MSc Fin London Adv Dip Aeth Med (FPD).
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