Catheter-Assisted Application of Hyaluronidase Combined With Multimodal Treatment After Hyaluronic Acid–Induced Ischemia of the Upper Extremity

In this study, the authors report the case of a 62-year-old female patient who presented with ischemia of the right dominant arm and hand after being injected with hyaluronic acid (HA) in the elbow crease. Imaging showed occlusion of the radial artery, the deep and superficial palmar arch and the common digital arteries, as well as the princeps pollicis artery because of an accidental injection of HA into the brachial artery. The aim of the authors is to discuss vascular complications after HA injections and present possible treatment options. Off-label treatment with hyaluronidase was chosen and administered in 2 treatment cycles. The patient received a total of 6000 units of catheter-delivered intra-arterial hyaluronidase and an additional 1500 units applied subcutaneously. A brachial plexus block was placed to promote vasodilatation. Because of severe occlusion, recombinant tissue-type plasminogen activator was administered during the second treatment cycle. Hyperbaric oxygen therapy was carried out for 3 weeks to avoid reocclusion. After the second intra-arterial hyaluronidase injection combined with lysis therapy, full revascularization of the upper extremity was achieved. Follow-up examinations were conducted to monitor sensory and motor recovery. No sequelae were observed. Off-label treatment with high-dose intra-arterial hyaluronidase and adjuvant treatment led to successful restoration of blood circulation after vascular occlusion because of intra-arterial HA injection. <b>Level of Evidence</b>: 5 (Therapeutic).