ethamolin and Arteriovenous-Malformations

Vascular anomalies are comprised of either hemangiomas or vascular malformations.Low-flow vascular malformations can be divided into capillary, venous, and lymphatic types and are usually present at birth, undergo pari passu growth, and produce symptoms related to mass effect or stasis. High-flow malformations are comprised pre-dominantly of arteriovenous malformations that follow a more aggressive clinical course of hyperemia, adjacent mass effect, steal phenomenon, tissue destruction, and ultimately high output failure. Ultrasound, CT, nuclear medicine, angiography, and particularly MRI have greatly enhanced diagnostic accuracy and provide detailed information for percutaneous and surgical treatment planning and an objective means of following therapeutic efficacy. Interventional radiologic percutaneous sclerotherapy for low-flow lesions and embolosclerotherapy for high-flow lesions with or without adjunctive surgical intervention have become the mainstay of therapy.

Topics: Antimetabolites, Antineoplastic; Arteriovenous Malformations; Bleomycin; Humans; Immunohistochemistry; Lymphatic Abnormalities; Magnetic Resonance Imaging; Oleic Acids; Radiography, Interventional; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate

The objective of this study was to report and discuss the results from treatment of benign oral vascular lesions with ethanolamine oleate.. Twenty-seven patients with 30 examples of oral vascular malformation, hemangioma, or varix were treated with intralesional injections of 1.25% or 2.5% ethanolamine oleate at an interval of 15 days between each application. The lesions were divided into 2 categories: (1) lesions of 20 mm or less and (2) those greater than 20 mm. Subsequently, the Mann-Whitney test was used a means of statistical analysis.. Although the number of injections varied from patient to patient, all lesions responded to the treatment, showing total clinical regression. Lesions of 20 mm or less needed a lesser number of applications than those greater than 20 mm (P < .05).. Ethanolamine oleate is a 100% effective sclerosant agent for treatment of benign oral vascular lesions. In this study, no difference was found between the 2 concentrations applied.

Topics: Adolescent; Adult; Aged; Arteriovenous Malformations; Child; Female; Hemangioma; Humans; Injections, Intralesional; Male; Middle Aged; Mouth Diseases; Mouth Neoplasms; Neoplasms, Vascular Tissue; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Statistics, Nonparametric; Varicose Veins; Vascular Diseases

To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing.. We describe a cohort of 15 consecutive patients. OVAs <20 mm were included. Clinical data of the OVAs were collected. Descriptive and bivariate statistical analyses were performed.. Fifteen of the 19 OVAs were varicosities and the lower lip was the most affected site (n = 7). The median size was 6 mm, and one session was required in 89.5% of cases for clinical healing within 28 days. The pain/burning score was low (<2) for most lesions (63.1%) and the degree of satisfaction was high (>8) for all OVAs. The number of applications, final volume of drug and time to resolution differed significantly according to the size of the anomaly.. The protocol with 5% EO was shown to be effective and safe to treat OVAs <20 mm, and with a decrease in the number of sessions, volume and time to resolution, without complications and with high patient satisfaction.

Topics: Aged; Aged, 80 and over; Arteriovenous Malformations; Cohort Studies; Female; Humans; Lip; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Varicose Veins; Vascular Diseases

The aim of this study was to evaluate the effectiveness and safety of 5% ethanolamine oleate (EO) foam in the treatment of low-flow venous malformations in the head and neck region. Seventeen consecutive patients (six male, 11 female) and 34 low-flow venous malformations were enrolled. The vascular anomalies ranged between 20mm and 80mm in size. The typical clinical indication was a swelling (88.2%) with a purple colour (85.3%); the most frequent location was the tongue (23.5%). Ethanolamine oleate foam was produced via the Tessari method and applied at 10mg per 1cm to the vascular anomalies. This process resulted in the highest clinical healing score in 64.7% of cases, and half of the patients reported a high level of satisfaction (score >9). In the majority of cases (88.2%), the patients reported that the pain immediately postoperative was mild or moderate. There were direct relationships between vascular anomaly size and the volume of EO applied, the number of sessions, and healing (P<0.05). No recurrence was observed during 6 months of follow-up. This case series showed the effectiveness and safety of 5% EO foam for the treatment of venous malformations in the head and neck region.

Topics: Adolescent; Adult; Aged; Arteriovenous Malformations; Child; Female; Head; Humans; Male; Middle Aged; Neck; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

This study was designed to assess the safety and effectiveness of ethanolamine oleate (EO) sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs).. Twenty-four patients with symptomatic AVMs in the head and neck (n = 15), extremity (n = 5), and trunk (n = 4) with a mean age of 44 years (range, 18-78) treated with EO sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 7 type II (arteriolovenous fistulae), 6 type IIIa (arteriolovenulous fistulae with nondilated fistula), and 11 type IIIb (arteriolovenulous fistulae with dilated fistula). Transarterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. EO mixed with contrast material was delivered by percutaneous direct puncture or by catheterization into the draining vein under balloon occlusion.. Three (13%) of 24 patients were cured, 17 (71%) had partial remission, and 4 (16%) no remission. Treatment was considered effective (cure and partial remission) in 20 patients (83%). Four patients (16%) experienced transient minor complications, including self-healing skin ulcer (n = 3) and localized deep venous thrombosis (n = 1). There were no major complications.. EO sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.

Topics: Adolescent; Adult; Aged; Angiography; Angioplasty; Arteriovenous Malformations; Cohort Studies; Combined Modality Therapy; Embolization, Therapeutic; Enbucrilate; Female; Follow-Up Studies; Humans; Male; Middle Aged; Oleic Acids; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Sclerotherapy is useful for the treatment of arteriovenous vascular malformations. However, intravascular administration of sclerotic agents into small arteriovenous niduses is often difficult. Extravascular administration of sclerotic agents causes reduction of vascular flow on Doppler echo during clinical sclerotherapy. Therefore, we aimed to investigate whether the extravascular injection of sclerotic agents affects tiny vessels.. Animal study.. The effect of extravascular injection of sclerotic agents on vessels was investigated using rat femoral and superficial inferior epigastric vessels.. After surgical exposure of vessels, absolute ethanol, 5% ethanolamine oleate and 3% polidocanol were injected into perivascular surrounding tissues, and their effect on vessels was evaluated after 14 days using histology and coloured silicone rubber injection.. The integrity of the vascular lumen, endothelial cells and vascular patency were not affected by injection of sclerotic agents.. Attenuation of vascular flow of an arteriovenous shunt after extravascular injection of sclerotic agents is transient and/or trivial and does not cause disruption of vessels. Therefore, sclerotic agents should be delivered to obtain sufficient destruction of arteriovenous malformation lesions and blood flow.

Topics: Animals; Arteriovenous Malformations; Disease Models, Animal; Endothelium, Vascular; Epigastric Arteries; Ethanol; Femoral Artery; Femoral Vein; Follow-Up Studies; Injections; Oleic Acids; Polidocanol; Polyethylene Glycols; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy; Solvents; Tissue Adhesives; Treatment Outcome

Sclerotherapy is effective in the treatment of vascular malformations. However, in lesions with relatively high blood flow, its effect is not always adequate. We therefore developed a three-grade classification of vascular malformations to facilitate the selection of treatments according to vascular flow. We also developed the technique of embolosclerotherapy, in which transarterial embolisation is done before sclerotherapy to control blood flow in the lesion during sclerotherapy. We now have 14 years' experience with 112 cases of vascular malformations of the head and neck treated with sclerotherapy. Results were evaluated with pretreatment and post-treatment photographs, and reduction of volume was calculated on findings from magnetic resonance imaging. Clinical improvement in 110 cases was graded as excellent in 32 (29%), good in 48 (43%), fair in 19 (17%), and poor in 11 (10%). In 84 cases, mean rate of reduction of volume was 35%. The most common complication was haemolytic haemoglobinuria (n=37, 33%). Our results suggest that this three-grade classification is useful to judge resistance to sclerotherapy and decide on treatment. Our experience indicates that ethanolamine oleate (EO), with or without arterial embolisation, was effective using our classification of vascular dynamics. We consider EO to be equivalent or superior to other sclerosants such as ethanol.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arteriovenous Malformations; Child; Child, Preschool; Embolization, Therapeutic; Head; Humans; Infant; Male; Middle Aged; Neck; Oleic Acids; Regional Blood Flow; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Young Adult

The purpose of this study was to assess the control of nidus blood flow and the association between such control and clinical outcomes after ethanolamine oleate (EO) sclerotherapy for vascular malformations.. Morphological grades on magnetic resonance (MR) images (grades 1-3), preprocedure nidus blood flow control, and clinical results in 22 cases of vascular malformation were reviewed.. Cases were subdivided by MR morphological grade as follows: grade 1, 3 patients; grade 2A, 6 patients; grade 3, 13 patients. Responses to EO sclerotherapy were as follows: excellent, 3 patients; good, 5 patients; poor, 14 patients. An excellent response was achieved in one grade 1 case, one grade 2A case, and one grade 3 case. Preprocedure nidus flow was controlled in 8 lesions (type A) and not controlled in 14 lesions (type B). Three (37.5%) type A lesions had an excellent response, five had a good response; and none had a poor response. All type B lesions had a poor response. Flow control predicted an excellent result (P < 0.05).. Preprocedure nidus blood flow control (versus lack of control) is associated with a significantly higher incidence of favorable clinical responses to EO sclerotherapy for vascular malformations.

Topics: Adolescent; Adult; Aged; Angiography; Arteriovenous Malformations; Blood Flow Velocity; Child; Contrast Media; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Oleic Acids; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Peripheral vascular malformations are now described according to some accepted guidelines, and the principle of proper treatment (nodus ablation) is becoming clear. An appropriate classification schema for vascular anomalies and definite indications for treatment are important to successful treatment overall. Non-invasive imaging (US, CT, and MRI) in association with clinical findings is critical in establishing the diagnosis, evaluating the extent of the malformation, and planning appropriate treatment. Direct nidus phlebography is useful not only in making a correct diagnosis but also in treating the lesion by sclerotherapy. When a patient suffers clinical complications, the nidus sclerotherapy becomes mandatory. If the vascular malformation remains bloodstream to a drainage vein during nidus opacification, flow control is necessary to achieve complete nidus ablation. A multidisciplinary approach is needed in the treatment of a high-flow lesion. A dedicated team approach is necessary for appropriate management in most cases.

Topics: Adolescent; Adult; Arteriovenous Malformations; Humans; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy