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Experimentally Induced Arterial Embolism by Hyaluronic Acid Injection

Clinicopathologic Observations and Treatment

Chen, Yin, M.D.; Zhang, You-liang, M.D.; Luo, Sheng-Kang, M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2019 - Volume 143 - Issue 4 - p 1088–1097
doi: 10.1097/PRS.0000000000005456

Background: Although major complications of hyaluronic acid injection rarely occur, with the rapidly growing number of procedures performed and their expanding applications, such complications warrant greater attention. Our study was designed to explore optimal treatment methods for hyaluronic acid–related vascular occlusion.

Methods: In the first part of the study, 60 rats were given intraarterial hyaluronic acid injected into the bilateral inferior epigastric arteries to establish an animal model, and were euthanized at different postinjection time points. The inferior epigastric artery was retrieved for pathologic examination. In the second part of the study, bilateral abdominal flaps supplied by the inferior epigastric artery were elevated in six groups of rats, and hyaluronic acid was injected into the right side, with each group receiving a different intervention. The flap survival rate was calculated and analyzed.

Results: In the first part of the study, pathologic examination revealed that the composition of the emboli caused by arterial hyaluronic acid–induced occlusion changed from pure hyaluronic acid to a hyaluronic acid–thrombus mixture. In the second part of the study, flap survival rates (mean percentages) were as follows: group A, 43.29 ± 9.28 percent; group B, 54.17 ± 10.86 percent; group C, 59.27 ± 13.40 percent; group D, 64.37 ± 8.61 percent; group E, 71.92 ± 19.06 percent; and group F, 57.47 ± 13.64 percent. Group A differed significantly from groups B, C, D, and E (p < 0.001). No significant difference was observed between groups A and F (p > 0.05).

Conclusions: The combined use of intravenous or subcutaneous hyaluronidase and urokinase was most effective in treating hyaluronic acid injection-related arterial embolism after 45 minutes and 24 hours. This treatment may be ineffective after 48 hours.

Guangzhou, Guangdong, People’s Republic of China

From the Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital; and the Southern Medical University.

Received for publication December 21, 2017; accepted September 10, 2018.

Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article. The study was not supported by any funding source.

Sheng-Kang Luo, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, Guangdong 510317, People’s Republic of China,

©2019American Society of Plastic Surgeons