Importance of Choke vessels in Injectable fillers
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Choke vessels are dormant vessels, which open up in special vascular compromise situations, and help to alter the circulation. This altered circulation may help in ameliorating the severity of damage caused by vascular occlusion after fillers.

An “angiosome” is a composite anatomical territory comprising the skin and underlying tissues vascularized by a specific source artery and its accompanying vein or veins. Its anatomical boundary is established by a perimeter of connecting vessels, which connect it with the adjacent angiosomes to form a continuous network. These connecting vessels, which connect adjacent angiosomes (both arterial and venous skin circulation), are called choke vessels. These “choke vessels” ordinarily lie dormant. They have the ability to dilate and become active during times of greater demand to facilitate increased blood flow. The relevance of choke vessels lies in the fact that they can play an important role in preventing or ameliorating complications following intra-arterial injection of hyaluronic acid fillers.

When blood flow to a particular region of skin is interrupted, an adjacent cutaneous perfusion territory can expand via choke vessels to compensate for the insufficient blood flow. Hypoxia and physical effects of blood flow are the major factors responsible for choke vessel’s function and change in caliber. Inflammation and mechanical force are other important contributing factors.

Maximum complications of fillers on face occur in the areas within the angiosomes of facial and ophthalmic artery arteries, often referred to as “danger zones of face,” irrespective of the site of injection. This territory of face constitutes the area of highest number of choke vessels. For dermatologists and plastic surgeons using injectable fillers, knowledge of choke vessels is relevant and important. Choke vessels can play a role in limiting the damage of inadvertent vascular injection of filler. Proper knowledge of the anatomy of vessels, technique, and volume of injection, all have bearing on prevention and management of vascular complications occurring after fillers.