References
Vascular occlusion

Abstract
Adverse vascular events (AVEs) are unequivocally the most feared complication resulting from injection of dermal filler. The potentially life-changing consequences, which include tissue necrosis, scarring, blindness, stroke and even death, are not always understood by clients seeking aesthetic intervention; however, these events can occur, even in the most experienced hands and injectors must acknowledge that the risk is impossible to eliminate completely. Detailed history taking, careful patient selection, in -depth understanding of vascular anatomy (and its variability) and safe injection technique should be practi sed in order to minimi se risks; early diagnosis and immediate action taken when an AVE occur s and clients should be appropriately counselled as part of the informed consent process of this possibility in advance of their procedure.
Vascular occlusion following injection of volumi sing materials is not a novel phenomenon. It was first described over 100 years ago, when injecting petroleum jelly to correct facial deformities caused by disease processes or injury, was practi sed. Migration, infection and infl0ammatory responses were also reported, much as they are today with modern fillers, although clearly much less often latterly, as a result of aseptic technique and biocompatible materials. Adverse vascular events (AVEs) have also been reported with other injected therapeutic substances. Nicolau syndrome was first described as livedo dermatitis and gangrene in 1925, following treatment of syphilis with bismuth salts (Kim and Chae, 2015). Subsequent cases, sometimes described as embolia cutis medicamentosa, have also been reported with non-steroidal anti-inflammatory agents (NSAIDs), steroids, antibiotics, sclerosing substances, vaccines, alpha antagonists, sedatives, immunomodulators, recombinant interferon and tumour necrosis factor. In principle, injected substances which are able to occlude due to their viscosity or their eff ects on vessel linings may cause AVE.
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