Inadvertent intra-arterial injection complicating ordinary and ultrasound-guided sclerotherapy

Intra-arterial injection is the most dreaded complication of sclerotherapy of varicose veins. The medical literature does not contain enough data to enable one to formulate a definitive strategy for either the prevention or treatment of this complication.

Seven cases of intra-arterial injection are presented. The causes of these accidents, the recognition of the signs that intra-arterial injection has occurred, and the treatment of these cases are discussed.

Intra-arterial injection occurs in a variety of different settings. The signs that an intra-arterial injection has taken place are variable, but in some cases there are no signs until irreversible tissue damage has already set in. Treatment protocols are based mainly on anticoagulation with heparin, which is administered both intravenously and subcutaneously.

Heparin, whether administered continuously by the intravenous route or subcutaneously (twice daily), makes affected areas look and feel better, but there is no proof that it alters the final outcome with respect to tissue necrosis. In agreement with previous authors, we believe that there is a beneficial effect. Coumadin, on the other hand, appears to be completely ineffective.

Protocols employing heparin should be considered in cases of suspected intra-arterial injection. The length of time heparin should be continued is uncertain. The best "treatment" is prevention.