Intra-arterial

The term intraarterial (ia) describes the introduction of substances, liquids or drugs into an artery . This can be done for therapeutic or diagnostic purposes, or unintentionally. It can be introduced continuously (continuous infusion), for a certain period of time ( infusion or injection ) or only once (injection). The location of foreign bodies (such as catheters ) in arteries is also referred to as intra-arterial.

Applications

In human medicine, the adjective intraarterial denotes the following introductions:

• Intra-arterial injection : Here, a drug, substance or liquid is usually introduced into an artery once and at great speed. The artery is punctured with an injection needle or an indwelling venous cannula before the substance is introduced . Contrast media in the context of X-ray images of the arterial vascular system (arterial angiography ) are introduced into an artery in this way. In principle, any artery can be punctured and injected for this purpose.
• Intra-arterial infusion : In this case, a substance, drug, or liquid is introduced into an artery over an extended period of time. For this purpose, the artery has to be punctured beforehand, which is done either using an indwelling venous cannula or a special indwelling artery cannula. The artery is punctured with the indwelling cannula and its steel stylet; to secure the intra-arterial location, the stylet is removed and the indwelling plastic dwells intraarterially. The continuous infusion of 0.9% saline solution as part of a bloody (intra-arterial) blood pressure measurement is an example of an intra-arterial infusion. In order not to clog the indwelling cannula with clotting blood, a 0.9% saline solution is continuously added at low speed ( rinsing ). The most common arteries are the radial artery or the femoral artery. The intra-arterial infusion of cytostatics such as cisplatin in the context of the treatment of brain tumors is also an example of an intra-arterial infusion. The isolated limb perfusion (ILP), in the treatment of soft tissue sarcoma in adulthood means of melphalan is also an example of an intra-arterial infusion. The injection or infusion of contrast media or clot-dissolving drugs ( thrombolytics ) into the coronary arteries as part of coronary angiography (for example in the case of unstable angina pectoris or myocardial infarction ) is an intra-arterial injection. However, the term arterial is rather uncommon in this context, and the more site-specific term intracoronary is used.

Advantages and disadvantages

The intra-arterial injections and infusions have the advantage of a more rapid distribution of the substance in the bloodstream, this only applying to the area of ​​the body supplied by the artery.

The intra-arterial injections and infusions have several disadvantages. There is a risk of thrombosis with or without the thrombi being spread ( embolism ) into the supply area of ​​the artery. A bleeding after puncture of an artery can be brought only with significantly higher costs to a halt as a bleeding from a vein. Thirdly, a puncture of an artery can lead to an insufficient supply of the area it supplies ( ischemia or infarction , necrosis ). In the worst case, an extremity can be lost, such as an accidental injection of a barbiturate . Intra-arterial infusions of cytotoxic drugs such as cisplatin cause an increased incidence of serious side effects such as blindness in the treatment of brain tumors.

Since the risks and side effects usually outweigh the possible advantages, the intravenous route is preferred and also used for the introduction of systemically acting drugs and fluids .

The invasive blood pressure measurement (intra-arterial blood pressure measurement) cannot be implemented in the manner of an intravenous blood pressure measurement, since the blood pressures are different venous and arterial. Even with isolated extremity perfusion, localized exposure to a cytostatic such as melphalan is the desired goal, which cannot be achieved with intravenous administration.

Individual evidence

1. ↑ Intra-articular injection
2. ↑ aerzteblatt.de
3. ↑ Information at link.springer.com

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