Vascular Complication in Aesthetic Medicine Treated with Hyperbaric Oxygenation

Abstract The most hazardous adverse reactions following hyaluronic acid injections in aesthetic medicine involve vascular complications, known as the Nicolau Syndrome. This article presents a vascular complication in the area of the upper part of the nasolabial fold following subcutaneous administration of 0.5 ml of hyaluronic acid. At the time of the injection, paling occurred, which was followed by livedo racemosa appearing an hour later. Upon the lapse of a week, an ulceration appeared. It was not until the tenth day after the hyaluronic acid injection that hyaluronidase was administered. After 15 hyperbaric oxygen exposures, the ulcer was completely healed

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A Safe Doppler Ultrasound–Guided Method for Nasolabial Fold Correction With Hyaluronic Acid Filler

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa153 ◽

2020 ◽

Cited By ~ 1

Author(s):

Won Lee ◽

Ji-Soo Kim ◽

Hyoung-Jin Moon ◽

Eun-Jung Yang

Keyword(s):

Hyaluronic Acid ◽

Doppler Ultrasound ◽

Rating Scale ◽

Vascular Complications ◽

Facial Artery ◽

Nasolabial Fold ◽

Filler Injection ◽

Ultrasound Evaluation ◽

Filler Injections ◽

Nasolabial Folds

Abstract Background Injection of hyaluronic acid filler, a common procedure for nasolabial fold correction, poses a risk of vascular compromise, which can result in skin necrosis and blindness. Objectives The aim of this study was to examine the facial arterial pathway in real time by Doppler ultrasound to avoid arterial complications during filler injections. Methods The facial artery pathway of 40 patients (80 nasolabial folds; 2 men and 38 women; mean age, 46.5 years; range, 28-72 years) was examined by Doppler ultrasound before hyaluronic acid filler injection. On the basis of this ultrasound evaluation, the filler injection targeted the subdermal, subcutaneous, and deep to submuscular layers by bypassing the facial artery. The efficacy of the filler injection was evaluated for each patient. Results The facial artery was detected lateral to the nasolabial fold in 31% of patients; it was detected beneath the nasolabial fold in the other patients as follows: subdermal layer, 13%; subcutaneous layer, 29%; muscular layer, 24%; and submuscular layer, 4%. The mean [standard deviation] Wrinkle Severity Rating Scale score was 3.68 [0.76] before injection and 2.28 [0.78] at 3 months after injection. Two patients experienced unilateral bruising of the nasolabial fold, which resolved after 2 weeks without treatment. Conclusions Doppler ultrasound can be considered as pretreatment tool for the prevention of vascular complications during filler injections to correct nasolabial folds. Level of Evidence: 4

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Nasolabial folds modeling — literature review

Journal of Face Aesthetics ◽

10.20883/jofa.10 ◽

2019 ◽

Vol 2 (1) ◽

pp. 46-54

Author(s):

Teresa Matthews‑Brzozowska ◽

Anna Swatowska ◽

Magdalena Tuczyńska

Keyword(s):

Hyaluronic Acid ◽

Literature Review ◽

Skin Condition ◽

Middle Part ◽

Nasolabial Fold ◽

Facial Skin ◽

Aesthetic Medicine ◽

Medical Databases ◽

Materials Used ◽

Nasolabial Folds

Introduction. Nasolabial folds are skin folds that run from both sides of the nose to the corners of the mouth. They are caused by the loss of fat in the dermis, followed by the loss of muscles in the middle part of the face.Aim. The aim of the work is to present contemporary knowledge of materials used for modeling nasolabial folds.Material and Methods. Medical databases PubMed, EBSCO Multiplier, were analyzed by entering the slogans: nasolabial folds, nasolabial folds, hyaluronic acid in nasolabial fold modeling, nasolabial fold correction. Analyzing the literature, data from eleven scientific articles from the last five years (2013–2018) were used.Results. In most articles for modeling nasolabial folds, crosslinked hyaluronic acid was used after prior photographic assessment of skin condition or after anamnesis examination — an interview. From the papers describing the cases, it appears that the applied materials for face aesthetic medicine treatments level the nasolabial folds.Conclusions. The obtained results are ambiguous and studies need to be continued. In the literature, the instrumental evaluation of facial skin was not used before modeling nasolabial folds.

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Use of vascular closure devices for endovascular interventions requiring a direct puncture of PETE grafts

VASA ◽

10.1024/0301-1526/a000677 ◽

2018 ◽

Vol 47 (2) ◽

pp. 119-124 ◽

Cited By ~ 2

Author(s):

Artur I. Milnerowicz ◽

Aleksandra A. Milnerowicz ◽

Marcin Protasiewicz ◽

Wiktor Kuliczkowski

Keyword(s):

Statistical Significance ◽

Vascular Complications ◽

Vascular Complication ◽

Inguinal Region ◽

Closure Device ◽

Manual Compression ◽

Direct Puncture ◽

Endovascular Interventions ◽

Vascular Closure Devices ◽

Closure Group

Abstract. Background: Effectiveness of vascular closure devices during endovascular procedures requiring a direct puncture of a vascular prosthesis placed in the inguinal region is unknown. Patients and methods: The retrospective analysis included 134 patients with a history of polyethylene terephthalate (PETE) graft implantation in the inguinal region. In 20 (15 %) patients, haemostasis was achieved with manual compression, in 21 (16 %) with the StarClose™, and in 93 (69 %) with the AngioSeal™ device. Results: The incidence of vascular complications in the manual compression group was higher (at a threshold of statistical significance) than in the device closure group (45.0 vs. 24.5 %, p = 0.059). The difference was considered statistically significant when manual compression was compared with the AngioSeal™ closure group (45.0 vs. 13.9 %, p < 0.01). The vascular complication rate in the StarClose™ group was significantly higher than in the AngioSeal™ group (71.4 vs. 13.9 %, p < 0.000001). While haematomas were the only vascular complications observed after application of AngioSeal™, both haematomas and pseudoaneurysms were found in the StarClose™ group. Conclusions: The AngioSeal™ vascular closure device provides better local haemostasis than the StarClose™ device or manual compression during endovascular interventions requiring a direct puncture of PETE grafts

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Advantages of Hyaluronic Acid and Its Combination with Other Bioactive Ingredients in Cosmeceuticals

Molecules ◽

10.3390/molecules26154429 ◽

2021 ◽

Vol 26 (15) ◽

pp. 4429

Author(s):

Anca Maria Juncan ◽

Dana Georgiana Moisă ◽

Antonello Santini ◽

Claudiu Morgovan ◽

Luca-Liviu Rus ◽

...

Keyword(s):

Hyaluronic Acid ◽

Glucuronic Acid ◽

Biological Effects ◽

Biological Processes ◽

Cosmetic Products ◽

Aesthetic Medicine ◽

Cosmetic Formulations ◽

Other Substances ◽

Bioactive Ingredients ◽

Brand Portfolio

This study proposes a review on hyaluronic acid (HA) known as hyaluronan or hyaluronate and its derivates and their application in cosmetic formulations. HA is a glycosaminoglycan constituted from two disaccharides (N-acetylglucosamine and D-glucuronic acid), isolated initially from the vitreous humour of the eye, and subsequently discovered in different tissues or fluids (especially in the articular cartilage and the synovial fluid). It is ubiquitous in vertebrates, including humans, and it is involved in diverse biological processes, such as cell differentiation, embryological development, inflammation, wound healing, etc. HA has many qualities that recommend it over other substances used in skin regeneration, with moisturizing and anti-ageing effects. HA molecular weight influences its penetration into the skin and its biological activity. Considering that, nowadays, hyaluronic acid has a wide use and a multitude of applications (in ophthalmology, arthrology, pneumology, rhinology, aesthetic medicine, oncology, nutrition, and cosmetics), the present study describes the main aspects related to its use in cosmetology. The biological effect of HA on the skin level and its potential adverse effects are discussed. Some available cosmetic products containing HA have been identified from the brand portfolio of most known manufacturers and their composition was evaluated. Further, additional biological effects due to the other active ingredients (plant extracts, vitamins, amino acids, peptides, proteins, saccharides, probiotics, etc.) are presented, as well as a description of their possible toxic effects.

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Complete percutaneous angio-guided implantation and explantation of VA-ECMO using preclosing for cardiogenic shock or cardiac arrest

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.209 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

R Gallet ◽

AS Martin-Tuffreau ◽

F Bagate ◽

M Boukantar ◽

G Saiydoun ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiogenic Shock ◽

Vascular Complications ◽

Vascular Complication ◽

Vascular Intervention ◽

Technical Success Rate ◽

Surgical Closure ◽

Refractory Cardiogenic Shock ◽

Distal Perfusion ◽

Va Ecmo

Abstract Funding Acknowledgements Type of funding sources: None. Background. The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Angio-guided percutaneous implantation and explantation could decrease vascular complications. Purpose We sought to describe the feasibility and safety of complete percutaneous angio-guided ECMO implantation and explantation using preclosing. Methods. All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018-09/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under fluoroscopic guidance. The occurrence of vascular complication was recorded. Results. Forty-nine patients underwent percutaneous VA-ECMO implantation for cardiogenic shock (n = 36) or refractory cardiac arrest (n = 13). Femoral vessel cannulations were successful in all patients and total cannulation time was 21± 8 min. Weaning from ECMO was possible in 23 patients (47%) and 11 (22%) patients were alive at 30-day. Significant vascular complications occurred in 3 patients (6%); all were related to distal perfusion line. One patient experienced major bleeding, and 2 experienced lower limb ischemia requiring vascular intervention (one failure of distal perfusion sheath implantation and one self-uprooting of the reperfusion cannula). Percutaneous decannulation was performed in 17 patients with 16/17 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. Among these patients, none required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO. Conclusion. Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique is an effective and safe strategy in patients referred for refractory cardiogenic shock or cardiac arrest.

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AB0864 DO CORTICOSTEROIDS AND HYALURONIC ACID INJECTIONS CAUSE INFECTIONS? A SYSTEMATIC REVIEW OF LITERATURE ON ADVERSE EFFECTS AND INFECTION RATES OF INTRA-ARTICULAR CORTICOSTEROID AND HYALURONIC ACID INJECTIONS IN PATIENTS WITH KNEE OSTEOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5799 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1739.2-1739

Author(s):

C. Hatzantonis

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Adverse Effects ◽

Adverse Events ◽

Knee Osteoarthritis ◽

Adverse Reactions ◽

Infection Rates ◽

Management Options ◽

Cochrane Reviews ◽

Number Of Patients

Background:Knee osteoarthritis has been a leading cause of chronic pain and disability in our increasingly aging population. Conservative management options of physiotherapy and oral analgesics offer some relief, but delivery of intra-articular injections such as corticosteroids or hyaluronic acid has increasingly become the mainstay of pain management of knee osteoarthritis. In a clinical setting, intra-articular injections offer a means to delay a total knee replacement. Despite the abundance of literature on corticosteroids and hyaluronic acid, there is no known percentage of infection rates or adverse effects that clinicians may use to inform patients prior to obtaining consent for the injection.Objectives:To determine a rate of adverse events and infection rates in patients undergoing intra-articular injections of corticosteroids or hyaluronic acid.Methods:A systematic review of current literature including studies involving patients ranging from 45 patients (Carmona L, 2018) to Cochrane reviews of 1767 patients (Campbell Kirk, 2015). From these studies, the number of patients, adverse reactions (i.e. pain, erythema) and serious adverse reactions (infections) were calculated.Results:Within our study, there was a large variation of numbers of adverse effects of hyaluronic acid and corticosteroids amongst studies, with percentages as variable as 0-9.3%. Corticosteroids demonstrated 11-26% reduction of adverse events compared to hyaluronic acid. However, confidence intervals were found to not be statistically significant.Conclusion:Intra-articular injections of corticosteroids and hyaluronic acid, although deemed clinically effective, continue to demonstrate variable rates of adverse effects and infection amongst patients with progressive knee osteoarthritis.Disclosure of Interests:None declared

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Post-injection embolia cutis medicamentosa – Nicolau Syndrome: case report and literature review

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.008315 ◽

2016 ◽

Vol 15 (1) ◽

pp. 70-73 ◽

Cited By ~ 1

Author(s):

Carlos Alberto Araujo Chagas ◽

Tulio Fabiano de Oliveira Leite ◽

Lucas Alves Sarmento Pires

Keyword(s):

Healthcare Professionals ◽

Subcutaneous Tissue ◽

Vascular Complication ◽

Benzathine Penicillin ◽

Intense Pain ◽

Large Ulcer ◽

Intramuscular Injections ◽

Nicolau Syndrome ◽

Left Buttock ◽

Embolia Cutis Medicamentosa

Abstract We report on the case of a 40-year-old male who was admitted to the clinic with a large ulcer on his left buttock, 3 days after an intramuscular benzathine penicillin injection. The patient was diagnosed with Nicolau syndrome, a rare vascular complication in which a lesion develops after intramuscular injection. Symptoms are intense pain at the injection site, erythema, and livedoid dermatitis, which leads to necrosis of skin, subcutaneous tissue and muscle tissue. It was described by Nicolau after intramuscular injections of bismuth salt for syphillis therapy. Nicolau syndrome is rare, but its symptoms are devastating and healthcare professionals must be aware of this clinical entity, since intramuscular injections are common procedures for administration of drugs.

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Risk factors for the development of micro-vascular complications of type 2 diabetes in a single-centre cohort of patients

Diabetes and Vascular Disease Research ◽

10.1177/1479164118780808 ◽

2018 ◽

Vol 15 (5) ◽

pp. 424-432 ◽

Cited By ~ 12

Author(s):

Marsida Teliti ◽

Giulia Cogni ◽

Lucia Sacchi ◽

Arianna Dagliati ◽

Simone Marini ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Risk Factor ◽

Peripheral Neuropathy ◽

Vascular Complications ◽

Glycated Haemoglobin ◽

Vascular Complication ◽

Single Centre ◽

Vascular Events

Aims: In type 2 diabetes, we aimed at clarifying the role of glycated haemoglobin variability and other risk factors in the development of the main micro-vascular complications: peripheral neuropathy, nephropathy and retinopathy. Methods: In a single-centre cohort of 900 patients, glycated haemoglobin variability was evaluated as intra-individual standard deviation, adjusted standard deviation and coefficient of variation of serially measured glycated haemoglobin in the 2-year period before a randomly selected index visit. We devised four models considering different aspects of glycated haemoglobin evolution. Multivariate stepwise logistic regression analysis was performed including the following covariates at the index visit: age, disease duration, body mass index, total cholesterol, high-density lipoprotein cholesterol, triglycerides, sex, smoking habit, hypertension, dyslipidemia, treatment with anti-diabetic drugs, occurrence of macro-vascular events and the presence of another micro-vascular complication. Results: Males with high mean glycated haemoglobin, long duration of diabetes, presence of macro-vascular events and retinopathy emerged at higher risk for peripheral neuropathy. Development of nephropathy was independently associated with higher glycated haemoglobin variability, older age, male sex, current smoking status, presence of retinopathy, of peripheral neuropathy and of hypertension. Higher mean glycated haemoglobin, younger age, longer duration of diabetes, reduced estimated glomerular filtration rate and the presence of peripheral neuropathy were significantly associated with increased incidence of retinopathy. Conclusion: Glycated haemoglobin variability was associated with increased incidence of nephropathy, while mean glycated haemoglobin emerged as independent risk factor for the development of retinopathy and peripheral neuropathy. The presence of macro-vascular events was positively correlated with peripheral neuropathy. Finally, the occurrence of another micro-vascular complication was found to be a stronger risk factor for developing another micro-vascular complication than the mean or variability of glycated haemoglobin.

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Hyaluronic acid filler vascular complication management: an updated and easy-to-follow emergency protocol

Journal of Aesthetic Nursing ◽

10.12968/joan.2021.10.sup1.34 ◽

2021 ◽

Vol 10 (Sup1) ◽

pp. 34-38

Author(s):

Erick Santaella-Sosa

Keyword(s):

Hyaluronic Acid ◽

Acid Concentration ◽

Current Literature ◽

Vascular Complication ◽

Complication Management ◽

Biophysical Properties ◽

Product Characteristics ◽

Physiochemical Properties ◽

Molecular Weights

With the breadth and variety of hyaluronic acid hydrogels available, it can be challenging to understand the evolving product characteristics and associated terminology. Similarly, different hyaluronic acid hydrogels can share the same indication, and yet consist of different rheological and physiochemical properties. In this paper, hyaluronic acid biophysical properties, such as molecular weights, stabilisation (crosslinking), modification and hyaluronic acid concentration, are explored in relation to findings from current literature. The significance for these specific properties is explored in relation to specific indications and anti-ageing benefits.

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Evaluation of the Rheologic and Physicochemical Properties of a Novel Hyaluronic Acid Filler Range with eXcellent Three-Dimensional Reticulation (XTR™) Technology

Polymers ◽

10.3390/polym12081644 ◽

2020 ◽

Vol 12 (8) ◽

pp. 1644

Author(s):

Giovanni Salti ◽

Salvatore Piero Fundarò

Keyword(s):

Hyaluronic Acid ◽

Research Laboratory ◽

Three Dimensional ◽

Size Distributions ◽

The Novel ◽

Independent Research ◽

Aesthetic Medicine ◽

Dimensional Network ◽

Pore Size Distributions ◽

Patient Profiles

Soft-tissue fillers made of hyaluronic acid and combined with lidocaine have recently become a popular tool in aesthetic medicine. Several manufacturers have developed their own proprietary formulae with varying manufacturing tools, concentrations, crosslinked three-dimensional network structures, pore size distributions of the fibrous networks, as well as cohesivity levels and rheological properties, lending fillers and filler ranges their unique properties and degradability profiles. One such range of hyaluronic acid fillers manufactured using the novel eXcellent three-dimensional reticulation (XTR™) technology was evaluated in comparison with other HA fillers and filler ranges by an independent research laboratory. Fillers manufactured with the XTR™ technology were shown to have characteristic rheological, crosslinking and biophysical factors that support the suitability of this filler range for certain patient profiles.

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