The study of histological changes of the arterial vascular structure after hyaluronidase exposure

Wattanakrai, Penpun; Jurairattanaporn, Natthachat; Rojhirunsakool, Salinee; Visessiri, Yingluck; Suwanchinda, Atchima; Thanasarnaksorn, Wilai

doi:10.1111/jocd.12719

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…Endothelium breakup of tunica intima was not observed, nor was the separation of the tunica intima and media in the embolism hyaluronidase high-dose group, unlike that reported by Wattanakrai et al, 29 who applied hyaluronidase intraarterially. Subcutaneous application in this study may be why it was avoided, besides being an in vivo model, influenced by blood flow, and different dispersion of the enzyme, among other variables that assimilate a clinical scenario.…”

Section: Discussioncontrasting

confidence: 68%

Hyaluronic Acid Embolism Treated with Subcutaneous High and Low Hyaluronidase Doses: Efficacy and Surrounding Tissue Effect

Salinas‐Alvarez

Welsh

Soto‐Domínguez

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Background: The use of hyaluronidase in hyaluronic acid vascular occlusion has been evaluated; however, the models used do not accurately assimilate the facial morphologic characteristics or study the effects on adjacent tissues. The purpose of this study was to determine an effective concentration of subcutaneous hyaluronidase to dissolve a hyaluronic acid embolism and its effect on surrounding tissue. Methods: Fifteen rabbits were divided into six groups. An inguinal incision was performed on the femoral artery to create a hyaluronic acid embolism in the control and treatment groups (low-, medium-, and high-hyaluronidase groups). Hyaluronidase was injected subcutaneously. Photographic follow-up, histologic analysis, and quantification of hyaluronic acid were performed. Kruskal-Wallis test and post hoc with Bonferroni correction (p < 0.05) was used to compare the presence of hyaluronic acid in the arterial lumen between groups. Results: Despite the persistence of intravascular hyaluronic acid, macroscopic and microscopic differences were found between the embolism control group and embolism hyaluronidase high-dose group. Histologic analysis demonstrated thrombosis throughout groups. Skeletal muscle was least affected in the embolism hyaluronidase 500 IU group with less lysis and inflammatory infiltrate. Conclusions: A 500 IU hyaluronidase dose partially prevents the damage caused by the embolism, and does not affect the surrounding tissue. The use of thrombolytic therapy combined with higher doses of hyaluronidase subcutaneously in this model is proposed.

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Section: Discussioncontrasting

confidence: 68%

Hyaluronic Acid Embolism Treated with Subcutaneous High and Low Hyaluronidase Doses: Efficacy and Surrounding Tissue Effect

Salinas‐Alvarez

Welsh

Soto‐Domínguez

et al. 2021

Plastic &Amp; Reconstructive Surgery

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“…Consequently, the use of high-dose intravenous hyaluronidase is currently being explored as a rapid, more accessible alternative to intra-arterial therapy, with some promising outcomes [ 216 , 217 ]. Given the short half-life of hyaluronidase in plasma (2–3 min), a high-dose, continuous infusion may be necessary to achieve sufficient reversal activity at distant sites of occlusion, potentially increasing the adverse effects of such systemic therapy [ 216 , 218 , 219 ].…”

Section: Pathophysiology Of Ha-mediated Vascular Occlusionmentioning

confidence: 99%

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

Soares

2022

Molecules

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Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.

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“…11 Following an occlusion, the endothelial cell damage gets accentuated. 12 The aberrant endothelial cell-vascular smooth muscle cell interaction could alter the vascular tone, thereby reducing the blood flow through the affected segment. 13,14 This was identified by the delayed flow and retention of the fluorescein dye in the affected segment and the occluded vessel seen on the AO imaging.…”

Section: Discussionmentioning

confidence: 99%

“…With time, there is degeneration of endothelial cells and separation of the tunica intima from tunica media. 12 This promotes vascular inflammation and thrombosis resulting in the reduction in the vessel lumen size. 15 In this case, we noted narrowing of the lumen size on the FA, enface OCT and AO imaging at the follow-up visits.…”

Section: Discussionmentioning

confidence: 99%

Retinal vessel wall imaging using fluorescein angiography and adaptive optics imaging in acute branch retinal artery occlusion

Venkatesh

Mutalik

Reddy

et al. 2022

European Journal of Ophthalmology

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Purpose To report the retinal vessel wall changes in a patient with acute branch retinal artery occlusion with fundus fluorescein angiography and adaptive optics imaging. Methods Retrospective, observational case Case description A 49-year-old female with cardiac ailment complained of sudden onset superior field loss for 4 days in her right eye. Her presenting visual acuity in the right eye was 20/20, N6. She was diagnosed with right eye infero-temporal branch retinal artery occlusion. A golden-yellow, round coloured embolus was noted on clinical examination obstructing the temporal division of the inferior branch of central retinal artery. Patient underwent ocular massage, anterior chamber paracentesis and oral Acetazolamide (Tab. Diamox 250 mg QID) medications. Vessel wall changes were noted using fluorescein angiography and adaptive optics retinal imaging at presentation and 10-day follow-up visit. Conclusion This case highlights the importance of multimodal retinal imaging like fluorescein angiography and adaptive optics imaging in identifying and understanding the retinal vessel wall changes in the occluded vascular segment of the retina.

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The study of histological changes of the arterial vascular structure after hyaluronidase exposure

Abstract: There were endothelial injuries in the arterial specimens after intravascular concentrated hyaluronidase injection.

Cited by 8 publications

References 21 publications

Hyaluronic Acid Embolism Treated with Subcutaneous High and Low Hyaluronidase Doses: Efficacy and Surrounding Tissue Effect

Hyaluronic Acid Embolism Treated with Subcutaneous High and Low Hyaluronidase Doses: Efficacy and Surrounding Tissue Effect

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

Retinal vessel wall imaging using fluorescein angiography and adaptive optics imaging in acute branch retinal artery occlusion

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