Clinical model of hyaluronic acid embolism treated with hyaluronidase and its effects on the arterial wall and adjacent tissues

Abstract

IntroductionHyaluronic acid (HA) is a glycosaminoglycan used cross‐linked to increase its durability and be used as a temporary facial filler. One of the most striking complications of its use is vascular occlusion, causing permanent lesions and scars. The use of hyaluronidase (HYAL) was evaluated subcutaneously (SC) and intra‐arterially (IA) in a lagomorph model causing an HA embolism in the ear, however, the model has few similarities to the clinical application site. In addition, different doses of HYAL have been evaluated, but they have not been compared to each other, nor has the safety of adjacent tissues been evaluated. Our aim was to determine an effective and safe concentration of HYAL applied extravascularly to dissolve an HA embolism.Materials and methodsWe used 15 New Zealand rabbits divided into 6 groups (Healthy, Surgical, Embolism, 75UI, 200UI, and 500UI). An HA (Belotero Balance®) embolism was performed in the left femoral artery to the embolism control group and to the three embolism groups treated with HYAL SC 1 hour after the embolism. Samples were taken in block obtaining artery, vein, nerve, muscle, and skin on the 5th day. Histologic staining and histochemistry was performed. Quantification of HA (Image J®) was performed, and morphological changes in the artery and adjacent tissues were analyzed. Study was approved by the Care and Use of Laboratory Animals and Ethics Committees.ResultsDespite the persistence of HA in the arterial lumen of the treated groups, a significant difference was found between the 200UI (p = 0.002) and 500UI (p = 0.001) groups of HYAL and the embolism control group. Sites of arterial thrombosis were observed in the embolism groups and those treated with HYAL. When evaluating the surrounding tissues, the muscle of the group treated with high dose had less muscle lysis and less inflammatory infiltrate.ConclusionA new lagomorph model of embolism due to HA was established with greater similarity to the site of clinical application than those already established. A high dose of HYAL, applied subcutaneously, partially prevents the damage caused by the embolism. The use of thrombolytic therapy combined with the use of higher doses of HYAL SC in this model is proposed.Support or Funding InformationNoneThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.