__NOTOC__ Extravasation is the leakage of a fluid out of its container into the surrounding area, especially

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in th ...

blood cell A blood cell, also called a hematopoietic cell, hemocyte, or hematocyte, is a cell produced through hematopoiesis and found mainly in the blood. Major types of blood cells include red blood cells (erythrocytes), white blood cells (leukocytes), ...

s from vessels. In the case of

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

, it refers to the movement of

white blood cells White blood cells, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from mult ...

from the

capillaries A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...

to the tissues surrounding them (

leukocyte extravasation Leukocyte extravasation (also commonly known as leukocyte adhesion cascade or diapedesis – the passage of cells through the intact vessel wall) is the movement of leukocytes out of the circulatory system and towards the site of tissue damage o ...

, also known as ''diapedesis''). In the case of malignant

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bl ...

metastasis Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then ...

it refers to cancer cells exiting the capillaries and entering organs (to form secondary tumors). It is frequently used in

medical Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...

contexts, either referring to

urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra. Cellul ...

, or to

. More specifically, it can refer to: * Extravasation (intravenous) * Extravasation of infusates * Extravasation of irrigation fluid * Extravasation of urine *

Leukocyte extravasation Leukocyte extravasation (also commonly known as leukocyte adhesion cascade or diapedesis – the passage of cells through the intact vessel wall) is the movement of leukocytes out of the circulatory system and towards the site of tissue damage o ...

* Angiopellosis (non-leukocyte cell extravastion)

Extravasation of irrigation fluid

Extravasation of irrigation fluid is the unintended migration of irrigation fluid (e.g. saline) introduced into a human body. This may occur in a number of types of endoscopic surgery, such as minimally invasive orthopedic surgery, i.e. arthroscopy, TURP (trans-urethral resection of the prostate) and TCRE (trans-cervical resection of the endometrium). In arthroscopy, fluid under pressure is used to inflate and distend a joint and make a working surgical space. Arthroscopy is typically performed on shoulder and knee joints; however, hip arthroscopy is becoming more popular. Arthroscopy is done by making surgical portals or puncture wounds into the joint. A surgical instrument called an arthroscope is used to introduce irrigation fluid under pressure to distend the joint. The arthroscope includes a small (typically 4 mm in diameter) optic scope rod to view the joint. Other portals or puncture wounds are made to introduce surgical instruments to perform cutting or repair procedures. If the joint is surrounded by soft tissue, as in the shoulder and hip, fluid under pressure may leak out of the joint space through the surgical portals and collect in the patient's soft tissue. A typical arthroscopy can result in 1–3 liters of irrigation fluid being absorbed into the patient's interstitial tissue. This buildup of irrigation fluid in the soft tissue may cause

edema Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area ma ...

. This swelling can interfere with the arthroscopic procedure by collapsing the surgical space, or migrating into the patient's neck and causing airway blockage. In hip arthroscopy, a feared complication is abdominal flooding where the irrigation fluid leaks from the hip joint capsule and drains into the abdominal cavity. Risk factors for fluid extravasation include procedure length (> 90–120 min), obesity, and age (> 45–50) with accompanying lack of muscle tone. Shoulder arthroscopy is typically limited to about 90–120 minutes before the swelling from fluid extravasation interferes with the procedure, and presents a potential risk to the patient. Typically, fluid extravasation is managed by controlling fluid pressure, or hastening the procedure. Arthroscopic instrumentation such as the newer Extravastat devices to drain extravasated fluid from the soft tissue during shoulder and hip arthroscopy has been reported to be beneficial in reducing fluid extravasation and swelling.

Extravasation of infusates

Extravasation may also refer to the leakage of infused substances from the vasculature into the subcutaneous tissue. The leakage of high-osmolarity solutions or chemotherapy agents can result in significant tissue destruction and significant complications.

References

* ''Complications in Orthopaedics: Shoulder Arthroscopy'', chapter "Severe Edema During Shoulder Arthroscopy" pp 9–16, Xavier A. Duralde, MD, editor. * ''Immediate postoperative fluid retention and weight gain after shoulder arthroscopy.'' LoIK, Burkhart SS. Arthroscopy. 2005 May; 21(5):605–610. * ''Life Threatening Airway Edema Resulting From Prolonged Shoulder Arthroscopy'', Steven L. Orebaugh, M.D. ''Anesthesiology'', V 99, No. 6, December 2003. * ''Severe Airway Obstruction During Arthroscopic Shoulder Surgery'', Stephan Blumenthal, M.D., Marco Nadig, M.D., Christian Gerber, M.D., Alain Borgeat, M.D. ''Anesthesiology'', V 99, No. 6, December 2003. * ''Complete Airway Obstruction During Shoulder Arthroscopy'', Hynson, J.M., Tung, A., Guevara, J.E., et al. ''Anesthesiology Analg'', 76:875–878, 1993. * ''Complications of hip arthroscopy'', Sampson, T.G. ''Clin Sports Med.'' 20(4):831–835, October 2001.

External links

Monograph on Complications in Shoulder Arthroscopy
published by the American Association of Orthopedic Surgeons (AAOS)
British National Health Service page on complications from extravasation of infusates

* [https://doi.org/10.1007%2Fs11999-009-0955-y Cannulae with Outflow Reduces Fluid Gain in Shoulder Arthroscopy Hasan M. Syed, Seth B. Gillham, Christopher M. Jobe, Wesley P. Phipatanakul and Montri D. Wongworawat] Medical terminology

Extravasation of irrigation fluid

Extravasation of infusates

See also

References

External links