Experimentally Induced Arterial Embolism by Hyaluronic Acid Injection: Clinicopathological Observations and Treatment

BACKGROUND: Although major complications of hyaluronic acid (HA) 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 HA-related vascular occlusion. METHODS: Part I: Thirty rats were given intra-arterial HA injected into the bilateral inferior epigastric arteries to establish an animal model and were euthanized at different post-injection time points. The inferior epigastric artery was retrieved for pathological examination. Part II: Bilateral abdominal flaps supplied by the inferior epigastric artery were elevated in six groups of rats, and HA was injected into the right side, with each group receiving a different intervention. The flap-survival rate was calculated and analyzed. RESULTS: Part I: Pathological examination revealed that the composition of the emboli caused by arterial HA-induced occlusion changed from pure HA to an HA-thrombus mixture. Part II: Flap-survival rates (mean percentages): Group A: 43.29±9.28%, Group B: 54.17±10.86%, Group C: 59.27±13.40%, Group D: 64.37±8.61%, Group E: 71.92±19.06%, Group F: 57.47±13.64% Group A differed significantly from groups B, C, D, and E (p0.05). CONCLUSION: The combined use of intravenous or subcutaneous hyaluronidase and urokinase was most effective in treating HA injection-related arterial embolism after 45 min and 24 h. This treatment may be ineffective after 48 h. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. The study is not supported by any funding source. Acknowledgements: None This article has not been presented at any meeting or conference. Corresponding author: Prof. Sheng-Kang Luo1,2 ©2019American Society of Plastic Surgeons

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