title: Intra-arterial injection of sclerosants: Report of three cases treated with systemic steroids.
abstract: Intra-arterial injection of sclerosants is a significant but uncommon complication of sclerotherapy that may result in extensive tissue necrosis and in rare cases digit or limb amputation. We have managed three cases in the past 10 years. One patient was referred for immediate treatment following intra-arterial injection of liquid polidocanol. The other two had undergone foam sclerotherapy with polidocanol and sodium tetradecyl sulphate, respectively. All patients were treated with a combination of oral steroids (prednisone 0.5-1 mg/kg) and systemic anticoagulants (enoxaparin 1.5 mg/kg daily subcutaneous injection). One case progressed to skin ulceration where prednisone was started five days after the adverse event and prematurely stopped after four weeks. The other cases did not progress to necrosis or other long-term sequelae. In these patients, prednisone was commenced immediately and slowly reduced over the following 12 weeks. The inflammation that follows ischemia plays a significant role in tissue necrosis and the immediate management of this adverse event may benefit from anti-inflammatory measures and in particular systemic steroid therapy unless contraindicated.
authors.affiliation: Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St. Vincent's Hospital, Sydney, Australia Department of Dermatology, St. Vincent's Hospital, Sydney, Australia University of New South Wales, Sydney, Australia kparsi@stvincents.com.au.
authors.forename: Kurosh
authors.initials: K
authors.lastname: Parsi
authors.affiliation: Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St. Vincent's Hospital, Sydney, Australia University of New South Wales, Sydney, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hannaford
mesh_terms: D000284:Administration, Oral; D000328:Adult; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000009:adverse effects*; D014648:Varicose Veins / Q000473:pathology / Q000628:therapy*
chemical_list: D017984:Enoxaparin; D012597:Sclerosing Solutions; D011239:Prednisolone
keywords: Sclerosants; foam; intra-arterial injections; sclerotherapy; steroids