Ethanol sclerotherapy of peripheral venous malformations

BACKGROUND: Venous malformations are congenital lesions that can cause pain, decreased range of movement, compression on adjacent structures, bleeding, consumptive coagulopathy and cosmetic deformity. Sclerotherapy alone or combined with surgical excision is the accepted treatment in symptomatic malformations after failed treatment attempts with tailored compression garments. OBJECTIVES: To report our experience with percutaneous sclerotherapy of peripheral venous malformations with ethanol 96%. PATIENTS AND METHODS: 41 sclerotherapy sessions were performed on 21 patients, aged 4-46 years, 15 females and 6 males. Fourteen patients were treated for painful extremity lesions, while five others with face and neck lesions and two with giant chest malformations had treatment for esthetic reasons. All patients had a pre-procedure magnetic resonance imaging (MRI) study. In all patients, 96% ethanol was used as the sclerosant by direct injection using general anesthesia. A minimum of 1-year clinical follow-up was performed. Follow-up imaging studies were performed if clinically indicated. RESULTS: 17 patients showed complete or partial symptomatic improvement after one to nine therapeutic sessions. Four patients with lower extremity lesions continue to suffer from pain and they are considered as a treatment failure. Complications were encountered in five patients, including acute pulmonary hypertension with cardiovascular collapse, pulmonary embolus, skin ulcers (two) and skin blisters. All patients fully recovered. CONCLUSION: Sclerotherapy with 96% ethanol for venous malformations was found to be effective for symptomatic improvement, but serious complications can occur.     

Duplex guided foam sclerotherapy plus compression for the treatment of chronic venous ulcer

Background and objective

Venous ulcers are the most severe and debilitating sequel of chronic venous insufficiency (CVI) and venous hypertension. They account for nearly 80% of all lower extremity ulcers, with an overall prevalence of approximately 1–2%. The majority of these patients are otherwise healthy individuals suffering from chronic ulceration during the most productive period of life.

Objective

The aim of this work is to prospectively evaluate the using of foam sclerotherapy guided by duplex ultrasound for injection of incompetent perforators to treat venous ulcer.

Materials and methods

This study was done on forty patients who were referred to management of chronic venous ulcer. All patients were subjected to: pre-treatment evaluation, Ankle brachial pressure index and venous duplex scan.

Results

As regards healing of leg ulcers in the 40 patients under this study: At 1, 3, and 6 months after treatment: 5 ulcers (12.5%), 28 ulcers (70%) and 38 ulcers (95%), respectively had healed completely 3 ulcers had recurred (8%) during the follow up period.

Conclusions

Compared to surgical intervention, the relative freedom from serious complications and its evident success, make this the first line treatment for venous ulcer.     

Percutaneous ethanol sclerotherapy of venous malformations of the tongue

BACKGROUND AND PURPOSE: Percutaneous ethanol sclerotherapy has been reported to be efficacious for head and neck venous malformations. We sought to evaluate the safety and efficacy of percutaneous sclerotherapy by using ethanol for treatment of symptomatic venous malformations of the tongue. METHODS: Eleven sclerotherapy procedures were performed in seven patients from January 1995 to February 2001. Patient age ranged from 19 months to 57 years (mean age, 32 years). Four patients were male and three were female. Mean follow-up was 36 months. The volume of ethanol used per treatment session ranged from 2 to 32 cc (mean, 16 cc). RESULTS: Sclerotherapy provided significant improvement or resolution of symptoms for all patients. There were no major complications. One patient had a small (3 x 2 cm) area of skin blistering at the injection site. All patients experienced pain and swelling to a variable degree. Sclerotherapy resulted in resolution of symptoms in six of seven patients. Three patients had resolution of symptoms after one procedure. Four patients each underwent two sclerotherapy procedures. One patient who remained symptomatic but improved after undergoing two procedures underwent an anterior glossectomy and is now asymptomatic. CONCLUSION: Percutaneous ethanol sclerotherapy is a safe and effective method of treating symptomatic venous malformations of the tongue.     

透视引导下鱼肝油酸钠泡沫硬化剂治疗下肢静脉曲张30例

目的 探讨用国产鱼肝油酸钠自制泡沫硬化剂治疗下肢静脉曲张的临床效果.方法 选择河南开封市第一人民医院30例(39 条患肢)下肢静脉曲张患者,对其进行透视引导下曲张隐静脉注射自制鱼肝油酸钠泡沫硬化剂,观察大隐静脉的闭合情况.结果 39 条患肢均成功注射泡沫硬化剂,平均每条患肢使用5.9 ml泡沫硬化剂.35条(90%)大...     

Endovascular treatment of venous malformations in extremities: results of sclerotherapy and the quality of life after treatment

Purpose: To evaluate the long-term results of endovascular sclerotherapy in treating venous extremity malformations and to assess the quality of life after treatment.

Material and Methods: Twenty-four patients were included who had completed treatment with ethanol sclerotherapy and a minimum of one year observation period. Nineteen patients attended a clinical control. To evaluate the quality of life after treatment, 23 patients filled in a questionnaire which included 20 multiple-choice questions exploring four dimensions: psychological, physical and social functioning, and pain.

Results: At the clinical control seven patients had no clinical symptoms related to the malformation, six had slight, four moderate, and two severe symptoms. In 16 patients the symptoms had diminished after treatment. No deterioration of the initial situation was observed. The results concerning quality of life showed that most patients did well after endovascular treatment. Pain was the most important injurious factor for state of health among the four different dimensions. The poorest outcome was found in malformations that filled the whole muscle or muscle compartment and in larger lesions. The patients whose malformation at the clinical control caused swelling to the extremity affected had poorer quality indices than others.

Conclusion: Endovascular treatment for venous malformations is an effective treatment.     

Soft-tissue venous malformations in children: percutaneous sclerotherapy with Ethibloc

Thirty-eight children with soft-tissue venous malformations (VMs) were treated with percutaneous injection of a new fibrosing agent (Ethibloc). The technique, results, side effects, and complications are detailed. Direct puncture of the VM allows evaluation of the draining venous system and direct injection of Ethibloc. This procedure alone or associated with surgery led to achievement of good or excellent results in 74% of the cases (complete cure in 50%), with minimal side effects and no major complications.     

MR导引下经皮硬化治疗四肢静脉血管畸形

目的 探讨MR导引下经皮硬化治疗四肢静脉血管畸形的操作方法及临床应用价值.方法 在0.35 T开放式MR扫描仪的导引下应用18或20 G核磁兼容针对28例下肢静脉血管畸形患者进行经皮穿刺及硬化治疗.在治疗后6个月进行随访,分析其治疗效果.评价指标包括:(1)介入操作是否成功;(2)患者的症状有无改善;(3)有无并发症;(4)病变体积的变化;(5)病变对比信噪比(CNR)的变化.治疗前后病变体积及CNR的比较使用配对t检验进行分析.结果 28例患者先后共进行57次硬化治疗,手术操作均获得成功,没有出现严重并发症.所有患者的症状均有较明显改善,特别是疼痛、功能障碍等症状.病变体积出现不同程度的缩小,治疗前平均为(56.8±11.7)cm3,治疗后平均为(27.0±7.2)cm3,差异有统计学意义(t=8.90,P<0.01),缩小率为28.5%～74.4%,平均为(54.4±5.3)%.同时,MRI显示治疗后病变的信号降低,CNR治疗前平均为21.9±2.0,治疗后平均为8.4±0.9,差异有统计学意义(t=21.76,P<0.01),CNR降低率为40.0%～78.0%,平均为(61.0±3.6)%.结论 MR引导下经皮硬化治疗四肢静脉血管畸形是安全、有效的新技术.     

DSA引导下经皮硬化术治疗儿童头颈部静脉畸形的临床价值

目的:探讨DSA引导下经皮硬化术治疗儿童头颈部静脉畸形的临床价值。方法:回顾性分析2009年1月-2013年12月我院收治的72例头颈部静脉畸形患儿的临床资料。所有患儿均行DSA引导下经皮硬化术治疗,根据瘤径采用分次、多种硬化剂联合治疗方法。较小的单发静脉畸形仅用无水乙醇治疗,而较大、多发静脉畸形联合应用聚桂醇治疗。末次治疗结束后行MRI检查评定疗效。结果:72例患儿进行2~6次治疗。42例治愈,21例显效,9例有效。随访(3个月~2年)均未发现静脉畸形复发。不良反应:2例皮肤破溃、坏死;4例表浅皮肤破溃,愈后无瘢痕;3例出现暂时性周围神经麻痹。结论:DSA引导下经皮硬化术是治疗儿童头颈部静脉畸形的有效方法。多种硬化剂联合、分次硬化治疗的原则有利于减少并发症和提高疗效。     

颅面部静脉畸形的无水乙醇介入硬化治疗

目的 总结无水乙醇介入硬化治疗颅面部静脉畸形的经验.方法 130例颅面部静脉畸形患者,均采用DSA监视下经皮穿刺无水乙醇硬化治疗.结果 130例患者共接受硬化治疗275次(1～18次/例),平均2.1次/例;单次治疗中的无水乙醇用量为0.5～40ml/次(平均10.3 ml次).随访时间为5～25个月(平均16个月).95例治愈,30例明显缓解.结论 无水乙醇介入硬化治疗颅面部静脉畸具有肯定疗效.     

Ethanol sclerotherapy of venous malformations: evaluation of systemic ethanol contamination

PURPOSE: To evaluate blood ethanol concentrations immediately after percutaneous ethanol sclerotherapy of venous malformations (VMs). MATERIALS AND METHODS: Thirty consecutive sclerotherapy procedures were performed for VMs in various anatomic sites. In a prospective study, the blood parameters monitored were ethanol plasma level (immediately after the procedure), plasma haptoglobin (Hp; before and after the procedure), and standard blood analysis including urea, creatinine, bilirubin, and lactic dehydrogenase (LDH) levels during the hospital stay. RESULTS: The mean amount of 94% ethanol injected was 19.7 mL (0.03-0.78 g/kg of body weight). The observed systemic ethanol levels ranged from 0 to 1.16 g/L (mean, 0.33 g/L, SD = 0.33). The relationship between the observed plasmatic ethanol level (ETOH plasma) measured immediately after the procedure and the maximum expected plasmatic ethanol amount (ETOH max) was linear and significant (correlation coefficient r = 0.91 for all lesions, r = 0.96 for lesions without visible venous drainage, r = 0.86 for lesions with visible draining veins, and r = 0.93 for lobulated VMs). Minimal changes were observed for indicators of hemolysis: macroscopic hemoglobinuria in five of 30, abnormal Hp level in seven of 30, and increase in LDH and increase in bilirubinemia in one case each. CONCLUSIONS: Systemic ethanol contamination during sclerotherapy of VMs could be detected in 25 of 30 cases (83.3%). The plasmatic ethanol level was directly proportional to the amount of ethanol injected and not dependent on the VM morphology, venous drainage, or injection technique. Clinicians and interventional radiologists must be aware of this massive ethanol outflow during percutaneous sclerotherapy of VMs and its potentially serious systemic complications.     

Craniofacial cavernous venous malformations: percutaneous sclerotherapy with use of ethanolamine oleate

PURPOSE: To assess the efficacy of percutaneous sclerotherapy with use of ethanolamine oleate for craniofacial cavernous venous malformations. MATERIALS AND METHODS: From 1991 to 2001, sclerotherapy (average of two procedures per patient) was performed in 29 patients (mean age, 22 y; 10 male) with craniofacial venous malformations. Direct puncture venography was performed with use of water-soluble contrast media to delineate the extent of the lesions. CO(2) gas was used as contrast medium in addition to water-soluble contrast media in five patients in whom lesions had large nondependent areas. Coil embolization with a transvenous approach was performed in two patients when the lesions had large draining veins. Then, a mixture of 5% ethanolamine oleate and iodized oil (ratio, 5:1-5:2) was injected manually into the lesions under fluoroscopic guidance to monitor the process. A total of 59 procedures were performed. Clinical follow-up was obtained in 25 of 29 patients. The duration of follow-up ranged from 10 days to 6 years (mean, 8.5 mo). The effectiveness of sclerotherapy was assessed on the basis of clinical, surgical, and radiologic findings. RESULTS: The procedures were effective in 14 of 16 patients who underwent sclerotherapy only. The procedures were beneficial for all nine patients who underwent sclerotherapy and surgery. There was no skin injury or nerve damage. The trismus that appeared in two patients with lesions in the masticator space was treated well by conservative therapy. CONCLUSION: Percutaneous sclerotherapy with use of ethanolamine oleate is a safe and effective treatment of craniofacial cavernous venous malformations. However, renal function was not specifically evaluated after treatment, and therefore occult renal dysfunction cannot be excluded.     

Polidocanol sclerotherapy for painful venous malformations: evaluation of safety and efficacy in pain relief

The aim of this study was to retrospectively evaluate the safety and efficacy of polidocanol sclerotherapy in pain relief for painful venous malformations (VMs). Thirty-one patients with painful VMs underwent polidocanol sclerotherapy. Pain intensity was assessed with an 11-point verbal numerical rating scale. Sclerotherapy was technically successful in 58 (98.3%) of 59 sessions. Twenty-six (89.7%) out of 29 patients experienced an improvement in pain after sclerotherapy at follow-up, a mean of 46 months after treatment. The mean pain score improved from 6.6?±?2.5 before treatment to 2.4?±?2.9 after treatment (P <.001). The factors that significantly influenced the therapeutic effect were size of lesion (P?=?.008), margin of lesion (P?=?.006), and stasis of sclerosant (P?=?.032). Adverse events included hypotension and bradycardia during the procedure. No major complication occurred. Polidocanol sclerotherapy is safe and most efficacious in providing pain relief for patients with small VMs (equal to or less than 10 cm in diameter), VMs with a well-defined margin, and VMs with good stasis of sclerosant during sclerotherapy.     

超声引导下聚多卡醇泡沫硬化治疗肾囊肿的临床应用价值

目的探讨超声引导下聚多卡醇泡沫在肾囊肿硬化治疗中的临床应用价值。 方法分析我院于2019年1月至2020年6月期间收治的42例肾囊肿患者,均在超声引导下行聚多卡醇泡沫硬化治疗,所有患者在术后1、3、6、12个月定期随访复查超声,根据囊肿的缩小率评价疗效。 结果42例患者的42个肾囊肿,术后1、3、6、12个月随访,治愈率分别为11.9%、35.7%、42.9%、59.5%;总有效率分别为59.5%、83.3%、92.9%、100.0%。Cox多因素回归分析显示囊肿容积的大小为影响聚多卡醇治疗效果的主要因素。 结论超声引导下聚多卡醇泡沫硬化治疗肾囊肿安全、有效,术后随访时间越长,治疗效果越显著,且囊肿容积越小,疗效越确切,值得在临床推广应用。