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PubMed1987

Primary lower extremity telangiectasias--relationship of size to color.

Sclerotherapy remains the treatment of choice for primary telangiectasias of the lower extremities, a half century after the treatment was first devised. No substantial improvements have been made, largely because little or no attention has been paid to the underlying physiology. Evidence is presented that these vessels are dilated by virtue of their proximity to small arteriovenous communications. This would explain the response these vessels demonstrate when injected with sclerosing solutions, as well as the relationship between their size and their color, which is documented by objective and subjective measurements. Two novel methods of treating telangiectasias with existing sclerosing solutions are described, and the characteristics of an ideal sclerosant for these vessels are proposed.

Arteriovenous Anastomosis↗
PubMedDate not supplied

The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections.

The cause of intermetatarsal neuromas or intermetatarsal neuritis is unclear; however, the most likely pathogenesis is either a mechanically induced degenerative neuropathy or entrapment of the intermetatarsal nerve as it passes under the transverse intermetatarsal ligament. Treatment of intermetatarsal neuromas includes the very simple method of changing shoe styles, more complex conservative treatments with functional orthotic devices, oral anti-inflammatory medications and cortisone injections, and surgical intervention. In this study, 100 adult patients with previously untreated intermetatarsal neuromas received three to seven injections of a 4% alcohol sclerosing solution every 5-10 days. No additional treatment was provided during the visits. The use of 4% alcohol sclerosing solution showed an 89% success rate. Of the 89 patients who were improved, 82 had complete resolution of symptoms. Eleven patients showed no improvement. The results of this prospective study indicate that the alcohol sclerosis treatment of intermetatarsal neuromas is a viable alternative to serial steroid injections or surgery for persistent symptoms.

Adult↗
PubMed2002

Treatment of varicose and telangiectatic leg veins: double-blind prospective comparative trial between aethoxyskerol and sotradecol.

BACKGROUND: One hundred twenty-nine patients were treated with either polidocanol (POL) or sodium tetradecyl sulfate (STS) to compare the efficacy and adverse sequelae of each agent. OBJECTIVE: To determine the safety and efficacy of two sclerosing solutions. METHODS: Each patient's leg veins that did not have incompetence from the saphenofemoral junction (SFJ) were divided into three categories by size (<1 mm, 1-3 mm, 3-6 mm). Each leg was randomly treated with either 0.25%, 0.5%, or 1.5% of STS or 0.5%, 1.0%, or 3% of POL respective of size. An independent, three-panel, blindly randomized photographic examination was obtained pretreatment and at 4 and 16 weeks. Patient satisfaction index and overall clinical improvement assessment were also obtained. RESULTS: All patients had an average of 70% improvement and were 70-72% satisfied in all vein categories treated with either solution. There was no significant difference in adverse effects between each group except for a decrease in ulcerations and swelling in the POL group. CONCLUSION: Both STS and POL are safe and effective sclerosing solutions for varicose and telangiectatic leg veins.

Double-Blind Method↗
PubMed1990

Incidence of side effects in the treatment of telangiectasias by compression sclerotherapy: hypertonic saline vs. polidocanol.

Two of the most common side effects of sclerotherapy of leg veins are telangiectatic matting (TM), and postsclerosis hyperpigmentation. A random sample of 113 female patients with similar treatment sites of telangiectasias (less than 1 mm in diameter) and venulectasias of 1-2 mm diameter on the legs were treated by sclerotherapy and assessed at 1 and 6 months later for the presence of TM and hyperpigmentation. Patients received treatment with either 23.4% hypertonic saline (HS) alone (N = 74), 1% polidocanol (POL) alone (N = 21), or a comparison treatment with both HS and 1% POL (N = 18). A subgroup of patients received both 1% POL and 0.5% POL (N = 10). The incidence of hyperpigmentation was related both to vessel size and to sclerosing solution; only one patient showed hyperpigmentation in a vessel less than 1 mm, while in 1-2 mm vessels the incidence was 10.9% for HS and 30.7% for 1% POL (p less than .004) at 1 month. At 6 months postsclerotherapy, the incidence of pigmentation was 2% for HS and 7.5% for 1% POL. Both the type and concentration of sclerosing solution affected the incidence of TM; the incidence of TM was 33% for 1% POL, compared to only 13% for HS (p less than .004). At 6 months follow-up, the incidence of TM decreased to 2% for HS and 9% for 1% POL. Ten patients who developed TM with 1% POL were treated subsequently with 0.5% POL and demonstrated no matting. These data indicate that the incidence of side effects was affected by both the concentration and type of sclerosant.

Female↗
PubMed1996

The intrinsic antimicrobial activity of selected sclerosing agents in sclerotherapy.

BACKGROUND: Detergent sclerosing agents may have intrinsic antimicrobial properties. In addition, they may have synergistic effects with other antibiotics such as penicillin. They may induce suppression of intrinsic resistance to penicillin in Staphylococcus aureus. OBJECTIVE: It is in this setting that the present study was carried out in order to determine the degree of suppression of resistance to methicillin and oxacillin in S. aureus by two detergent sclerosing solutions. METHODS: Four strains of S. aureus including a quality control strain were isolated. The minimal inhibitory concentration (MIC) of Sotradecol 1.0% and Polidocanol 0.5% were determined in Mueller Hinton Broth. These dilutions were subsequently seeded with 10(5) organisms of the strain of S. aureus being tested. Serial dilutions of penicillin were made and then the sclerosing agents were added in the appropriate dilutions. RESULTS: Sotradecol 1.0% produced a MIC of 1/64 in two strains of S. aureus and 1/128 in two other variant strains. Polidocanol 0.5% produced a MIC of 1/64 against two strains of S. aureus and an MIC of 1/8 and 1/4 with two other variant strains. In addition, in three of the four S. aureus strains both sclerosing agents had synergistic activity with penicillin and augmented its activity approximately 16-fold. CONCLUSION: This study presents the first successful modification in which detergent sclerosing solutions influence methicillin resistance in a Staphylococcal species. This points out a new potential therapeutic indication for this class of agents.

Anti-Bacterial Agents↗
PubMed2006

Management of mandibular vascular malformation with sclerotherapy. Report of two cases.

BACKGROUND: Management of vascular anomalies is extremely challenging and varies according to the nature of the lesion. Traditionally, embolization with the resection of the lesion and autologous immediate reconstruction has been used. The purpose of this report is to present cases successfully using sclerosing solution injections alone. METHODS: This paper describes the management of two cases of the mandibular vascular malformations using trans-osseous injection of the sodium tetradecyl sulfate to the periphery of the lesion. The procedure was performed four or five times at two weeks intervals respectively. Imaging was performed using subtraction arteriography and sequential panoramic dental radiographs. RESULTS: Radiological and histological evaluation of the cases showed resolution of the lesions following sclerotherapy alone. CONCLUSIONS: Conservative interventional management using trans-osseous injection of sclerosing solution was successful in treating mandibular vascular anomalies.

Adolescent↗
PubMed2003

Treatment of intermetatarsal Morton's neuroma with alcohol injection under US guide: 10-month follow-up.

Morton's neuroma (MN) is a frequent cause of metatarsalgia. The aim of our study was to evaluate the efficacy of neuroma alcohol-sclerosing therapy (NAST) under US guide in MN after a 10-month follow-up. Forty intermetatarsal neuromas underwent alcohol-sclerosing therapy after sonographic evaluation of their dimensions and echotexture. After subcutaneous anesthesia, a sclerosing solution composed of anesthetic (carbocaine-adrenaline 70%) and ethylic alcohol (30%) was injected inside the mass under US guidance. The procedure was repeated at intervals of 15 days until the resolution of the symptoms. A total or partial symptomatic relief was obtained in 36 cases (90%). No procedure-related complications were observed. Transitory plantar pain, due to the flogistic reaction induced by the sclerosing solution, occurred in 6 cases (15%). The 10-month follow-up revealed a 20-30% mass volume reduction and an adiposus-like change in echotexture. In the 4 cases (10%) of therapeutic failure, the preliminary sonography demonstrated a hypoechoic echotexture with a strong US beam attenuation corresponding to a highly fibrous neuroma after surgical resection. The NAST is a feasible and cost-efficient procedure with high rates of therapeutic success.

Adult↗
PubMed1994

Hyperosmolar versus detergent sclerosing agents in sclerotherapy. Effect on distal vessel obliteration.

BACKGROUND: Sclerosing agents produce local endothelial destruction extending to the adventitia of the vessel wall while producing minimal thrombosis formation. They are rapidly inactivated in order to prevent damage far beyond the injection site. It has been stated that detergent sclerosants may have more distal sclerosing capabilities than hyperosmolar sclerosants. OBJECTIVE: The present study compares the in vivo relative potential of polidocanol (POL.), a detergent sclerosing agent, and hypertonic saline (H.S.), a hyperosmolar sclerosant in their effects on distal vessel obliteration. METHOD: Symmetrical Class III reticular vessels of 2-3-mm diameter were injected with equal amounts (0.5 cc) of sclerosing solutions: 0.5% POL. in the left leg and 23.4% H.S. in the right leg. Distance of vessel sclerosing effect was calibrated from the inferior patellar tendon employing a calibrated measuring window. Standard compression (20-30 mm Hg) was employed for 72 hours after each treatment session. Patients were examined at 2-, 4-, 6-, 8-, 10-, and 16-week intervals for vascular sclerosing resolution effect. RESULTS: The mean distance of vessel sclerosis utilizing 23.4% H.S. was 6.24 cm vs 6.34 cm utilizing 0.5% POL. The mean duration of time to clinical disappearance of treated vessels was 6.4 weeks for the H.S.-treated extremity vs 6.2 weeks of the POL.-treated extremity. The difference of both parameters in terms of distance of sclerosing effect and time interval to achieve this effect were not statistically significant for either variable utilizing POL. or H.S. CONCLUSIONS: Hyperosmolar and detergent sclerosants such as POL. and H.S. in comparable concentrations for given vessel diameter may provide equal degrees of vessel obliteration clinically over equivalent periods of time in vivo. Other factors such as minimal sclerosant concentration, hypersensitivity/complication profile, patient discomfort, sclerosant availability, and physician experience are other important factors in choosing a sclerosing agent for a given clinical setting.

Adult↗
PubMed1986

Extravascular effects of sclerosants in rabbit skin: a clinical and histologic examination.

Sclerotherapy refers to the injection of a material for the purpose of obliterating a blood vessel. During this procedure a small quantity of sclerosing solution may be unintentionally injected into the tissues surrounding the vessel, either by missing the vessel or leakage of sclerosant upon withdrawal of the needle. Occasionally, the sclerosant may be intentionally injected into an extravascular site in the hope of reducing telangiectatic mats (best described as multiple, grouped, extremely fine telangiectatic vessels). The various sclerosants in use appear to vary in their potential to cause necrosis of perivascular tissues as a complication. This study examines the clinical and histologic effects of the intradermal injection of 0.1 ml of 0.25, 0.5, and 1.0% Aethoxysklerol (AES); 0.5% Sotradecol (SOT); and 23.4% hypertonic saline (HS) in rabbit skin. All three agents produced some clinical necrosis with intradermal injection. AES in all three concentrations produced the least clinical necrosis, no histologic necrosis, and resolved faster than SOT or HS.

Animals↗
PubMed2003

[Treatment of a femoral venous aneurysm with foam-sclerotherapy].

Venous aneurysms are uncommon. Venous dilatation and large varices could be treated with injections of foam and sclerosing agents followed by local compression which obliterate or thrombose the aneurysmal space. However, the use of foam-sclerotherapy to obliterate venous aneurysms has never been reported before. The obstruction or sclerosis of the aneurysmal space should be obtained without altering the femoral flow. The patient is a 65-year old lady without history of trauma involving the femoral region. A compressible lump is present at the third, internal part of the left femoral fold. The lump is painless and easily obliterated by compression. Color duplex shows a large cavity (4 x 4 x 6 cm) and venous flow is visible. Flow produces a venous jet, visible with color and ejecting from the common femoral vein. A first injection is made under ultrasound guide using a foaming agent: 10 ml of foam including 4 ml of 3% sclerosing solution are injected. During the injection the femoral vein is compressed with the probe to avoid passage of the sclerosing foam into the femoral vein. After 2 weeks, ultrasound indicate only a partial occlusion of the aneurysm. The procedure is repeated and after 2 more weeks the ultrasound scan shows a complete occlusion of the aneurysm. The femoral vein and the long saphenous vein are patent. After 12 weeks the situation is unchanged and the results appear to be permanent. This new method, never described before is an important, minimally invasive method in case of venous aneurysms. Results from larger studies should be available to define indications and modalities of treatment.

Aged↗
PubMed1989

Sclerotherapy: a personal appraisal.

Sclerotherapy is still an excellent procedure for treatment of sunburst venous blemishes. The technique is basic, as described previously. Points to remember are: 1. Use a syringe suited to the size of your hand. The disposable 3-cc syringe fits most hands, and does not require a reload after injection of 1 cc of sclerosant. The TBC syringe may be too long, and holds only 1 cc of sclerosant. 2. Be sure your needle is sharp. Change your needle as often as needed. It is surprising what a difference this can make. 3. Magnify your work! 4. Once you are in the vein, keep your eye on target (the needle point). A fractional deviation can cause you to perforate the tiny blood vessel. 5. Don't aim your needle under the vein; go parallel to it. 6. Inject a small bolus of air before the sclerosant solution. This ensures that you are in the venule and reduces chances of local side effects. Therefore, the syringe and needle must be tilted up, or else the bolus of air is behind the solution. 7. Remember to always store your hypertonic saline separately from all other injectables.

Humans↗
PubMedDate not supplied

[Sclerosis of varicose veins in patients on anticoagulants. Apropos of the report of 2 patients on anticoagulants].

The article refers to two cardiac patients on anticoagulants, one of them has an aortic valve, the other has had a myocardiac infarction, both have varicose lower members associated with trophic disorders. Cases of sclerotherapy on weak patients using antivitamin K (anti-coagulant solution) are rare. Usually the classic technique of sclerotherapy using Aetoxisclerol (Polydaconol) is used in the treatment of such cases. Both results have been good and without incidence. The concentrations of sclerosant solution are more or less the same those used for patients not on anticoagulant. Taking into account the results of these two cases, we should not as a matter of course refuse treatment to varicose patients on anticoagulants.

Aged↗
PubMed1983

Topical sclerotherapy of esophageal varices.

We have treated two patients with upper gastrointestinal bleeding due to esophageal varices, with a procedure first described in the 1930s, sclerotherapy of the varices. The procedure involves multiple injections of a sclerosing solution into the varices, utilizing a fiberoptic endoscope.

Adult↗
PubMed1985

Hemorrhagic pancreatitis: a complication of transcatheter embolization treated successfully by total pancreatectomy.

Since pancreatitis can be produced experimentally in dogs by embolization of microspheres into the pancreatic arterial circulation, there has been speculation that intentional or inadvertent embolization of the pancreas in human subjects could also produce pancreatitis. Although such therapeutic embolization has increased, no pathologically documented case of this complication has been recorded. We have reported the first such case occurring in a patient with a large, highly vascular, nonfunctioning islet cell carcinoma of the tail of the pancreas preoperatively embolized with Gianturco coils and Gelfoam particles suspended in sodium tetradecylsulfate solution to facilitate distal pancreatectomy. The resultant hemorrhagic pancreatitis and duodenal necrosis required a total pancreatectomy. We conclude that, by itself, occlusion of the origin of the splenic and gastroduodenal arteries with coils would have been effective and without complication; however, the addition of Gelfoam particles in a sclerosing solution reduced the microscopic pancreatic circulation to a critical point and resulted in hemorrhagic pancreatitis.

Adenoma, Islet Cell↗
PubMed1985

Gastric ulcers after endoscopic sclerosis of esophageal varices.

Two patients with bleeding esophageal varices underwent endoscopic sclerosis. Each developed a gastric ulcer of the fundic mucosa approximately 6-7 cm below the gastro-esophageal junction. It seems probable that these lesions were related to the retrograde flow of sclerosing solution into the venous system which drains the gastric mucosa.

Endoscopy↗
PubMed1995

Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. Etiology, prevention, and treatment.

BACKGROUND: Telangiectatic matting and hyperpigmentation are some of the most commonly observed side effects of sclerotherapy. Cutaneous necrosis is relatively rare and often of limited sequelae but most commonly related to extravasation of sclerosant. Physicians treating varicosities and telangiectasia by sclerotherapy must be familiar with causes and means for minimization of all three side effects. OBJECTIVE: This review article discusses the proposed etiology, risk factors, approach for minimizing, and suggested treatment for the three side effects of cutaneous necrosis, telangiectatic matting, and hyperpigmentation. RESULTS: Cutaneous necrosis may occur with the injection of any sclerosing agent even under ideal circumstances and does not necessarily represent physician error. When sclerosant extravasation occurs, dilution must occur immediately. Telangiectatic matting is a recognized complication occurring in approximately 15-20% of patients treated by sclerotherapy. Although the exact mechanism of the phenomena remains unknown, reactive inflammatory and/or angiogenic mechanisms are felt to play a role. Patients are advised that telangiectatic matting is usually not permanent and usually resolves spontaneously in 3-12 months. Postsclerosis pigmentation is defined as the appearance of persistent, increased pigmentation running the course of an ectatic blood vessel treated by sclerotherapy. The general incidence of hyperpigmentation ranges from 10 to 30%. Although hyperpigmentation may persist for months, its presence rarely deters patients from continuing treatment. Spontaneous resolution occurs in 70% at 6 months with 99% resolution occurring within 1 year. CONCLUSIONS: With understanding the etiology, risk factors, and ways to minimize these side effects our goal is to reduce their incidence. Attempting prevention may ultimately be the most effective means of treatment. Dermatol Surg 1995;21:19-29. LEARNING OBJECTIVES: After studying the following article, participant should be able to: 1. Understand the definition and potential causes of cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. 2. Advise patients prior to treatment on the common risks involved in sclerotherapy and to advise them on the relative incidence. 3. Understand the concept of minimal sclerosant concentration and how it can help the physician to choose sclerosing solution concentrations to minimize risks.

Dermatology↗
PubMed2003

Sclerotherapy treatment of telangiectasias and varicose veins.

Telangiectasias and/or varicose veins are present in about 33% of adult women and 15% of adult men. Although they may be only of cosmetic concern, superficial varices often cause significant symptoms such as pain, aching, heaviness, and pruritus. Venous ulceration is commonly caused solely by superficial venous insufficiency. Superficial thin-walled veins may rupture and hemorrhage. Sclerotherapy is a nonsurgical procedure that can be used to treat both small and large varices of the superficial venous system and perforators. This involves injecting a sclerosant intraluminally to cause fibrosis and eventual obliteration of a vein. The most common sclerosants used in the U.S. include sodium tetradecyl sulfate, polidocanol, 23.4% saline, and a combination of 25% dextrose with 10% saline. Treatment generally proceeds from proximal to distal and largest to smallest vein, based on a reflux map developed from physical examination, Doppler, and duplex ultrasound. Sclerotherapy results can be optimized and the risk of complications minimized by choosing the proper sclerosant, sclerosant concentration, sclerosant volume, and injection sites for the vein(s) being treated. Post-treatment instructions, particularly compression and ambulation, are designed to improve the results and safety of sclerotherapy. Adequate understanding of an appropriate history and physical, ultrasound evaluation, anatomy, pathophysiology, knowledge of sclerosing solutions, patient selection, and post-treatment care, as well as the ability to prevent, recognize, and treat complications are required before embarking on treatment.

Adult↗