Intra-arterial Air Thrombogenesis after Cerebral Air Embolism Complicating Lower Extremity Sclerotherapy

Abstract

We provide radiological evidence of hyperbaric oxygen therapy resolving intraarterial air but also demonstrate the thrombogenic potential of this procedural complication.

Paradoxical embolism, stroke and sclerotherapy

“…106 Secondary thrombosis following bubble exposure was reported in one PSS patient where thrombi were observed in the affected artery following the dissolution of the gas emboli. 7 Bubbles can also cause a progressive decline in cerebral blood flow even if they do not completely occlude vessels. 117,121 The nomenclature referring to the observed bubbles has been varied and often less than accurate.…”

Ultrasound-guided foam sclerotherapy is a safe and clinically effective treatment for superficial venous reflux

“…The etiology of these isolated events remains to be determined and further studies are required. [18][19][20][21] However, the fact that visual disturbances have been reported following liquid sclerotherapy suggests that mechanisms unrelated to bubbles, such as vasospasm from the sclerosant itself or secondary to vasoactive moieties released from venous endothelium as it is destroyed, may be involved.…”

Neurological complications of sclerotherapy for varicose veins

“…26 Other proposed mechanisms include the fact that symptoms occur as a result of air embolus, and confirmatory MRI images of air bubbles in the cerebral circulation of symptomatic patients suffering CVA have been reported. 12,13 Similar neurological symptoms have also been observed in divers after surfacing, whereby air bubbles have been shown to cause transient neurological symptoms. 27 It has also been suggested that an inflammatory reaction to the sclerosant may cause vasospasm resulting in symptoms.…”

“…The timing of the onset of symptoms was highly variable. In eight cases, symptoms occurred within minutes of treatment, 7,8,12,13,16,17 in three cases this occurred at 1 to 4 hours, 14,15,18 two cases reported symptoms the following day within 24 hours, 11,13 and the remaining cases were at 2 days, 3 days, and 5 days following treatments. 9,10,13 In two cases, residual weakness was observed at the time of discharge from hospital, and there was one reported fatality in the case of the patient who suffered a hemorrhagic stroke.…”

“…Confirmatory cerebral imaging of the presence of CVA was confirmed either by computed tomography imaging (CT) in four patients [7][8][9][10] or magnetic resonance imaging (MRI) in six patients. [11][12][13][14] One patient had normal MRI imaging but, due to persistent symptoms for 2 days, was classified as having had a CVA, 15 and one patient had thrombus in the right middle cerebral artery on autopsy. 16 The earliest case report found was in 1947, published in the British Medical Journal, of transient hemiplegia and speech disturbance in a 32-yearold female after the injection of sodium morrhuate, 16 and in 1951, a 62-year-old female patient who died shortly after injection of sodium morrhuate into varices 16 was found to have evidence of intracranial hemorrhage and thrombus in the middle cerebral artery at postmortem.…”