Management of Arterial Complications in Patients with Inadvertent Arterial Injection

Abstract

Aim: The aim of this study is to assess complications in inadvertent arterial injection and their management. Methods: From June 2018 to May 2020 in Tanta University Hospitals vascular and endovascular surgery department, this study was conducted on 30 patients with inadvertent intra-arterial drug injection complications, including femoral artery pseudoaneurysm, acute ischemia, and compartment syndrome. In 20 patients with femoral artery pseudoaneurysm, proximal control to external iliac artery and assessment of the vascularity was done intra-operatively for distal arterial Doppler flow. If the distal arterial flow was present, ligation of the common femoral artery was done, While if it was absent, iliofemoral bypass was done. Brachio-ulnar bypass was done for brachial artery pseudoaneurysm. Fasciotomy was done for compartment syndrome. Results: The mean age of patients was 27.4 years ranged from 1 year to 64 years. The femoral artery was affected in 20 cases. The brachial artery was involved in 6 cases, radial artery in 2 cases, and ulnar artery in 2 cases. In 20 patients, ligations of the common femoral artery CFA with debridement of necrotic were done for all cases. Twelve patients had good Doppler flow, eight patients had no Doppler flow, and iliofemoral bypass was done. In the upper limb cases, one case presented by severe edema in hand necessitating fasciotomy. Four cases presented with fixed color changes and gangrene in fingers after one brachial, one radial, and two ulnar arteries injections and required minor amputation. Two cases were presented with neglected ischemia and extensive infection, and above the elbow, amputation was done. In three cases with brachial pseudoaneurysm, we ligated the brachial artery, and no bypass was done with the preserved distal flow in one case; in the other two cases of brachial artery pseudoaneurysm, we did brachio-ulnar bypass. Conclusion: Inadvertent IA injection of medications has no appropriate therapeutic guidelines. The actual incidence rates, natural history, and pathophysiologic factors surrounding these complications are unclear. For prevention, the best tools are the assessment of the risk factors and consequences. The treatment options are immediate recognition of the situation, disease progress, pain control, anticoagulation, specific therapy.