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PubMed2003

Treatment of venous malformations with sclerosant in microfoam form.

BACKGROUND: Treatment of congenital venous malformations poses a major clinical challenge. Surgery is difficult and frequently unsuccessful, radiological intervention with embolization has an ill-defined role, and conventional sclerotherapy has little to offer. OBJECTIVE: To evaluate the efficacy and safety of sclerosant in microfoam form in treating congenital venous malformations. DESIGN: A retrospective study of medical records, pretreatment and posttreatment color photographs, echo-Doppler ultrasonographic results, and/or magnetic resonance imaging in patients with congenital vascular malformations of venous predominance. Follow-up ranged from 6 to 103 months (mean, 30 months). SETTING: Private vascular surgery clinic in Granada, Spain, and dermatology department at a university hospital in Pamplona. Patients The study population comprised 50 patients, 19 with limited venous malformations, 16 with infiltrating venous malformations, and 15 with Klippel-Trénaunay syndrome.Intervention Percutaneous sclerotherapy by direct injection of 0.25% to 4% polidocanol microfoam under du-plex ultrasonographic guidance. The number of sessions varied between 1 and 46 (mean, 12 sessions). MAIN OUTCOME MEASURE: The primary efficacy end point was defined as a reduction in size after completion of the treatment. RESULTS: Sclerosis therapy with polidocanol microfoam was judged beneficial in 46 (92%) of the 50 patients. Among the 46 responders, 18 showed disappearance of treated malformations, 15 showed a reduction in malformation size of more than 50%, and 13 showed a reduction in malformation size of 50% or less. Of the 39 patients who presented with pain, the pain disappeared in 25 and was reduced in 14. No major adverse effects were reported by any patient. There were 4 cases of transient skin pigmentation and 3 cases of skin necrosis. CONCLUSIONS: Color echo-Doppler ultrasonography-guided sclerotherapy with polidocanol microfoam was effective in 46 (92%) of the patients. The technique is delivered on a strictly ambulatory basis and has proved simple and innocuous. The quality and durability of the outcome make this novel procedure the treatment of choice in the care of patients with congenital venous malformations.

Adolescent↗
PubMed2004

Ultrasound-guided injection of polidocanol microfoam in the management of venous leg ulcers.

BACKGROUND: Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating surgery) is only possible in a subset of patients with leg ulcers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments. OBJECTIVE: To evaluate the efficacy and safety of sclerosant in microfoam in treating venous leg ulceration. DESIGN: A retrospective study of medical records, pretreatment and posttreatment color photographs, and echo Doppler in patients with venous leg ulceration. All patients were evaluated at 6 months after therapy, 70% were also evaluated at 2 years, 25% at 3 years, and 14% at 4 or more years after treatment. They were assessed for complete (100%) ulcer healing, time to wound closure, and recurrence. SETTING: Private vascular surgery clinic in Granada and dermatology department at a hospital in Pamplona, Spain. PATIENTS: Over 115 months, 116 consecutive patients (mean age [range], 57 [25-85] years) treated with ultrasound-guided injection of polidocanol microfoam (UIPM). INTERVENTIONS: To reduce venous hypertension, UIPM was used to selectively and progressively sclerose sources of incompetence. The number of sessions per patient varied between 1 and 17 (mean, 3.6). MAIN OUTCOME MEASURES: Complete ulcer healing, defined as full reepithelialization of the wound with absence of drainage. Recurrence was defined as epithelial breakdown in the healed limb. RESULTS: At 6-months' follow-up, treatment with UIPM achieved complete healing in 83% of patients (96/116), with median time to healing of 2.7 months; 7 patients were never cured, and 1 patient was lost to follow-up. There were recurrences in 10 patients. CONCLUSIONS: The use of UIPM to selectively and progressively sclerose incompetent veins produced by venous hypertension is highly effective to achieve a stable ulcer healing with minimal invasion, even in elderly patients. Recurrences are easily treatable with this approach. This technique may become a first-line treatment in the management of leg venous ulcers.

Adult↗
PubMedDate not supplied

Percutaneous ethanol sclerotherapy for vascular malformations in the head and neck.

Vascular malformations are frequent in the head and neck. In addition to the occasional devastating cosmetic effects of large vascular malformations, some may cause significant functional impairment by encroaching on the eye, tongue, or throat. Large lesions may produce a breakdown of skin or mucosa, with resultant leakage of blood or fluid and possible infection in the lesions and surrounding tissues. Arteriovenous malformations, in particular, may develop massive bleeding spontaneously or with minor trauma. Numerous treatment options are available for treatment of these lesions. Surgical excision is the traditional treatment for vascular malformations in the head and neck. However, some lesions may be difficult to remove when they permeate and envelop normal structures, such as the facial nerve, and a less invasive mode of therapy may prevent damage to these normal structures. Percutaneous sclerotherapy was developed as a minimally invasive treatment modality for these lesions. It has also proved helpful as a preoperative adjunctive treatment of these lesions to reduce surgical blood loss and to delineate the surgical extent of resection.

Arteriovenous Malformations↗
PubMed1986

Tetracycline sclerotherapy for chylous fistula following neck dissection.

In chylous fistulas following radical neck dissections, we have found reexploration to be unrewarding, with infrequent identification of a specific leakage site intraoperatively and persistent fluid accumulation postoperatively. As an alternative, we injected tetracycline hydrochloride into the supraclavicular wound bed. This procedure resulted in a rapid, sustained decline in fistula output in two of three cases, avoiding surgical intervention. Tetracycline sclerotherapy has been described for treatment of intrathoracic and other intracavitary fluid collections. We believe that tetracycline sclerotherapy is an effective adjunct in the management of chylous fistulas following radical neck dissections and that this therapy should be attempted before surgical reexploration.

Adenocarcinoma↗
PubMed1996

OK-432 therapy for lymphangiomas.

OBJECTIVE: To assess the efficacy of OK-432 sclerotherapy in the treatment of lymphangiomas. DESIGN: Nonrandomized trial; follow-up, 4 to 29 months. SETTING: Academic tertiary referral medical center. PATIENTS: Six children with presumed lymphangiomas; age range at initial treatment, 1 month to 7 years 10 months. INTERVENTION: Fluoroscopically guided cyst aspiration, cystography, and injection of OK-432. OUTCOME MEASURES: Clinical and radiographic comparisons before and after therapy. RESULTS: Complete response in 2 macrocystic lymphangiomas; no response in 3 microcystic lymphangiomas; and no response in 1 venous malformation. CONCLUSION: OK-432 sclerotherapy may be effective treatment for macrocystic lymphangiomas.

Child↗
PubMed2000

Variceal rebleeding and recurrence after endoscopic injection sclerotherapy: a prospective evaluation in 204 patients.

HYPOTHESIS: Eradication of esophageal varices by repeated injection sclerotherapy and maintenance of eradication using continued surveillance endoscopy may reduce recurrent variceal bleeding and death from esophageal varices. DESIGN: A prospective study of consecutive adult patients with endoscopically proved esophageal variceal bleeding. SETTING: A tertiary care university hospital in a metropolitan area. PATIENTS: Two hundred four patients (127 men and 77 women; mean age, 50.1 years; age range, 16-82 years) underwent 993 emergency and elective variceal endoscopic injection treatments with 5% ethanolamine oleate during 1992 endoscopy sessions. Most (166 [81.4%]) had cirrhosis, mainly due to alcohol abuse (131 [78. 9%]). The number of patients with each modified Pugh-Child risk grade was as follows: A, 30; B, 91; and C, 83. (The modified Pugh-Child classification comprises ascites, encephalopathy, serum albumin and bilirubin levels, and prothrombin time. Each variable is given a value of 1 to 3 with increasing impairment of liver function. Addition of the values leads to the Pugh-Child risk grades for each patient, with 5 and 6 giving grade A; 7 through 9, grade B; and 10 through 15, grade C, respectively.) RESULTS: Ninety-five patients (46.6%) rebled at a median of 17 days (range, 0-2583 days). Seventy-four patients (36.3%) had a total of 112 further bleeding episodes before eradication of varices. Varices were eradicated in 99 (87.6%) of 113 patients who survived longer than 3 months after a median of 5 injections and remained eradicated in 43 (mean follow-up after eradication, 38 months; range, 4-125 months). Rebleeding was markedly reduced after eradication of varices. Varices recurred in 56 patients, of whom only 10 rebled from recurrent esophageal varices. Cumulative survival by life table analysis was 55%, 41%, and 30% at 1, 3, and 5 years, respectively. One hundred thirty-seven patients (67.2%) died during follow-up. Liver failure was the most common cause of death. Minor complications (mucosal ulceration) occurred in 105 patients. Major complications, including a localized injection site leak (n = 9), esophageal stenosis (n = 25), and esophageal perforation (n = 5), occurred in 39 patients. CONCLUSIONS: Repeated injection sclerotherapy eradicated esophageal varices in most long-term patients. Complications related to injection sclerotherapy were mostly minor. Complete eradication of varices reduced rebleeding and death from esophageal varices.

Esophageal and Gastric Varices↗
PubMed1976

Transhepatic variceal sclerotherapy.

We attempted to control variceal hemorrhage, using transhepatic variceal sclerotherapy of a coronary varix. The procedure transiently controlled hemorrhage, but bleeding resumed from short gastric varices hours later.

Adult↗
PubMed1980

Sclerotherapy of esophageal varices.

Sclerotherapy of esophageal varices is being reevaluated by many surgeons because of increasing dissatisfaction with shunting procedures. A new technique of sclerotherapy using the flexible fiberoptic endoscope with balloon tamponade of variceal channels is being evaluated. To date, 18 patients have been treated by us with this method. Nine patients with active bleeding had control of their hemorrhage. Two patients experienced three episodes of rebleeding. Of patients not actively bleeding at the time of injection, one patient experienced rebleeding and subsequently died. Four other deaths not related to varices have occurred in this series. All surviving patients underwent repeated sclerotherapy until eradication of varices was achieved. This report demonstrates the feasibility of sclerotherapy of esophageal varices using the flexible fiberoptic endoscope.

Adolescent↗
PubMed1983

Rational approach to treatment of hemorrhoids based on a theory of etiology.

In a series of 600 patients suffering from hemorrhoidal symptoms, 709 treatment procedures were performed. Only 7% of the patients required hemorrhoidectomy. In the remaining patients, symptoms were relieved by conservative therapy comprising sclerotherapy, band ligation, or cryotherapy of the internal hemorrhoids only. On the basis of this series, the following proposals are made: (1) the concept of hemorrhoidal destruction should be replaced by one of fibrosis, (2) only the internal hemorrhoids need be treated, (3) hemorrhoids need not be treated unless they produce symptoms and then only the symptoms need be treated, (4) only those far-advanced hemorrhoids in which there has been extensive fragmentation of the supportive connective tissue need be treated surgically, and (5) treatment may be chosen according to the stage of the hemorrhoids.

Adolescent↗
PubMed1983

Cost of treatment of bleeding esophageal varices.

We examined the cost of four methods of treatment of bleeding esophageal varices--medical treatment, sclerotherapy, variceal ligation operations, and portal systemic shunts--in 49 consecutive patients from 1977 to 1979, and correlated the two-year outcome with cost. We found that, despite bias imposed by selection, the cost per patient and cost per survivor at two years was lowest in patients who received sclerotherapy, even though they were more seriously ill than patients who received other treatments. Patients treated with sclerotherapy also had the lowest mortality during primary hospitalization and the lowest readmission rate during a two-year period.

Adult↗
PubMed1984

Obliteration of the gallbladder without formal cholecystectomy. A feasibility study.

Obliteration of the gallbladder without formal cholecystectomy was attempted in 36 rabbits, using an open technique for cannulation of the gallbladder during laparotomy. The gallbladder was cannulated, the proximal cystic duct was occluded with cyanoacrylate-nitrocellulose 2% wt/wt, and the gallbladder mucosa was exposed to various sclerosing agents to induce fibrosis. Heated 60% diatrizoate meglumine and absolute alcohol induced a controllable chronic cholecystitis with transmural fibrosis within two weeks, a result not seen with morrhuate sodium or in the control groups. All animals survived without complications, and no instances of common bile duct damage or occlusion was noted. The results reported are promising and indicate the need for further studies of this technique for its efficacy and safety.

Animals↗