ethamolin and Vascular-Malformations

Laryngeal venous malformation is a comparatively rare condition in adults. It presents as a livid or bluish mass that may cause bleeding, hoarseness, stridor, and even difficulty in breathing. So far, treatment has largely consisted of laser therapy and surgical removal. Five cases of adult laryngeal venous malformations that were treated by sclerotherapy (local injection of monoethanolamine oleate solution) are reported. All lesions disappeared after one or two treatment sessions, and two of the five cases that presented recently were cured in the outpatient clinic setting with no sequelae. Sclerotherapy with monoethanolamine oleate is a safe, easy, and effective treatment for laryngeal venous malformations.

Topics: Adult; Female; Humans; Larynx; Male; Middle Aged; Oleic Acids; Remission Induction; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Veins

To compare the clinical outcome between ultrasound-guided foam sclerotherapy (UGFS) and ultrasound-guided liquid form sclerotherapy (UGLS) in patients with venous malformations (VM).. Eighty-nine patients with symptomatic VM were treated with ultrasound-guided sclerotherapy. There were 22 males and 67 females with mean age of 14.5 years. The sclerosing agents used were 1% polidocanol (POL) or 10% ethanolamine oleate (EO). POL was injected predominantly into smaller, superficial lesions, whereas EO was used for large, deeper lesions. Foam sclerosing solution was provided using Tessari's method. Patients were randomized to receive either UGFS or UGLS. Post-sclerotherapy surveillance was done at 6 months after last session using duplex ultrasound. Findings obtained by duplex scanning were divided into four groups: (1) disappeared group: the venous space was occluded and was totally shrunk; (2) partially recanalized group: the venous space was partially recanalized and was partially shrunk; (3) totally recanalized group: the venous space was totally recanalized and returned at the same size; and (4) worsened group: the venous space was totally recanalized and became worse.. Forty-nine patients were treated with UGFS and the remaining 40 were treated with UGLS. There were no significant differences in age and men:women ratio. There was no significant difference in the anatomic distribution of VMs between the two groups. The amount of POL was significantly smaller in patients who were treated with UGFS (P = .022). Similarly, there was a significant reduction in the use of EO in patients treated with UGFS (P = .005). The proportion of VM with total disappearance and partial recanalization was significantly higher in patients treated with UGFS (P = .002). No major complications related to sclerotherapy were encountered in both groups.. These findings suggest that UGFS could have greater promise compared with UGLS in the treatment of VMs.

Topics: Adolescent; Adult; Female; Humans; Male; Oleic Acids; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Ultrasonography, Interventional; Vascular Malformations; Veins

To investigate the efficacy of sclerotherapy with monoethanolamine oleate (MEO) in a series of cases of benign oral vascular lesions (BOVL).. Clinical records and images were retrieved (2015-2019), and data regarding age, gender, location, size, symptomatology, treatment and outcomes of patients were collected. All patients were diagnosed according to the classification of International Society for the Study of Vascular Anomalies and received the same treatment protocol (MEO 0.05 g/mL). The collected data were submitted to descriptive analysis and Pearson's chi-square test (p ≤ 0.05).. Thirty-seven patients were treated. Most were female (70.3%) aged 9 to 88 years (median, 57.5 ± 17.4 years). Lower lip (54.1%) was the most affected site followed by buccal mucosa (16.2%). Thirty-two lesions were asymptomatic and 35.1% showed ≤ 0.5 cm in size. In 48.6% of the patients, only one application of MEO was performed. Complete regression occurred in 62.2% of cases, whereas 27% showed partial regression. One patient showed hypersensitivity during treatment. There was no significant difference between clinical outcome and age, anatomic site, size, and number of applications of MEO.. Sclerotherapy with MEO is an acceptable and affordable treatment and can provide satisfactory results in BOVL, especially where other treatment options could compromise the esthetic aspects.. As it is a non-invasive therapy leading, in most cases, to adequate clinical results, safety, and tolerability, sclerotherapy with MEO can be considered an effective treatment for BOVL.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Esthetics, Dental; Female; Humans; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations; Young Adult

Venous malformations (VMs) are congenital disorders that constitute about 40% of all vascular anomalies. These lesions do not regress spontaneously and may increase in size during childhood. The case of a 10-year-old girl with an extensive oral VM is reported. Intraoral examination revealed the presence of purplish nodules in the alveolar mucosa and gingiva from anterior maxilla. Doppler ultrasound showed a well-defined hypoechoic image and increased vascularization with low blood flow for the alveolar mucosa lesion. The patient was submitted to intralesional injections of the ethanolamine oleate/mepivacaine sclerosing solution. After four sessions, there was a significant reduction of the lesions. However, the patient abandoned the treatment and the oral VM grew progressively. After 1 year, sclerotherapy was resumed and performed weekly. After 10 session of sclerotherapy, the oral VM totally regressed. The childhood is a critical period for oral VM growth. Doppler ultrasound and sclerotherapy can be effective for the management of extensive lesions in children.

Topics: Angiography; Child; Female; Humans; Injections, Intralesional; Mepivacaine; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Vascular Malformations

Sclerotherapy is an essential component of the treatment for venous malformations, and ethanolamine oleate (EO) is known as a useful sclerosing agent. However, macroscopic haemoglobinuria (MH) and subsequent renal impairment are severe complications after sclerotherapy using EO. The present study aimed to clarify the MH risk factors for better peri-operative management of venous malformations.. Data collected during 130 procedures involving 94 patients who were undergoing sclerotherapy using EO for venous malformation were retrospectively analysed. Pre-operative and operative variables, including sex, age, pre-operative body mass index, location, depth, type of lesion, size, number of procedures, type of drainage vein, ratio of sclerosant to air, and injected total dose of 5% EO per body weight (BW), were examined. Univariable analysis and multivariable logistic regression were performed to determine the possible risk factors for MH.. Macroscopic haemoglobinuria is a reversible complication if immediate and appropriate interventions with aggressive hydration and haptoglobin administration are performed; therefore, it should be closely monitored following sclerotherapy, especially when using 5% EO ≥ 0.18 mL/kg.

Topics: Adult; Dose-Response Relationship, Drug; Female; Fluid Therapy; Haptoglobins; Hematologic Agents; Hemoglobinuria; Humans; Male; Oleic Acids; Risk Adjustment; Risk Factors; Sclerosing Solutions; Sclerotherapy; Severity of Illness Index; Treatment Outcome; Vascular Malformations; Veins

Purpose This manuscript describes the technique of real-time MRI-guided sclerotherapy for low-flow venous malformations in the head and neck based on our institutional experience. Materials and methods Ethanolamine oleate is used as the sclerosant and is mixed with gadolinium for visualization during the procedure. The five procedural steps include: (I) an initial tri-plane T2-weighted sequence to visualize the lesion; (II) a T1 FSE or trueFISP sequence to assess needle placement and advancement within the lesion; (III) a tri-plane T1 FLASH sequence to monitor sclerosant injection; (IV) a T1 FSE or VIBE sequence to assess sclerosant coverage of the malformation before needle removal; (V) a post-procedural tri-plane T1 fat-saturated sequence to confirm sclerosant coverage of the lesion. Periprocedural medications typically include steroids, antibiotic prophylaxis, and non-steroidal anti-inflammatory medication. Patients are typically admitted for overnight observation. Conclusion Real-time MRI-guided sclerotherapy for low-flow venous malformations in the head and neck is effective and safe.

Topics: Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Brain; Female; Gadolinium; Head; Humans; Magnetic Resonance Imaging; Middle Aged; Neck; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Steroids; Stochastic Processes; Vascular Diseases; Vascular Malformations

The minimally-invasive nature of sclerotherapy makes it one of the first treatment options for venous malformations, although treatment-related complications, such as peripheral nerve paralysis, have been reported in some clinical cases. However, no studies of the aetiology of the detrimental effects of intraluminally-administered sclerotic agents on the surrounding tissues, including the peripheral nerves, have yet been published. This study therefore investigated the influences of intraluminally-administered sclerotic agents on the tissues surrounding the injection site using a newly-developed rat femoral vein model. Using this model, the effects of absolute ethanol, 5% ethanolamine oleate, and 1% polidocanol were compared histologically with those of normal saline controls. Fluorescein isothiocyanate-conjugated agents were administered and the leakage of sclerotic agents through the venous wall was evaluated by fluorescence microscopy. Damage to the adjacent femoral nerve was quantitatively evaluated by counting the numbers of axons in cross-sections. All the sclerotic agents caused vascular wall injuries and leakage into the surrounding tissues. The number of axons in the femoral nerve was significantly reduced following administration of absolute ethanol or 5% ethanolamine oleate, compared with normal saline. The results of this study suggest that sclerotic agents commonly leak out the vascular lumen, and some agents can cause adjacent nerve injury. It is important to be aware of this type of complication of sclerotherapy for venous malformations when selecting appropriate therapeutic interventions.

Topics: Animals; Capillary Permeability; Endothelium, Vascular; Ethanol; Extravasation of Diagnostic and Therapeutic Materials; Femoral Nerve; Femoral Vein; Fluorescein-5-isothiocyanate; Injections, Intravenous; Microscopy, Electron, Scanning; Oleic Acids; Polidocanol; Polyethylene Glycols; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy; Vascular Malformations

The aim of the present study was to relate the use of 5% monoethanolamine oleate in sclerotherapy for vascular malformations and to suggest a protocol for its use.. A total of 53 patients with 66 vascular malformation lesions were treated with an intralesional injection of 5% monoethanolamine oleate at 0.1 mL/cm of lesion with at least a 15-day interval and as many as 4 applications. A descriptive statistical analysis was performed using SigmaPlot, version 9.0, software.. The treatment with the protocol suggested was effective in 65 cases, and in 1 case, surgical intervention was required.. Sclerotherapy was effective in the treatment of vascular malformations, and the method chosen was adequate for lesion resolution without complications.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Face; Female; Humans; Infusions, Intralesional; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Young Adult

To evaluate the outcome and complications of sclerotherapy with injection ethanolamine oleate for the treatment of venous malformations (VMs).. Eighty-three patients' (39 males and 44 females) age ranging from 3 months to 21 years with 85 lesions were followed clinically for about 1 year following treatment with injection of ethanolamine oleate. The cases were enrolled between January 2006 and December 2009. The amount of ethanolamine oleate per treatment session ranged from 0.50 to 10 ml, and maximum dose was 0.40 ml per kg body weight. All patients were evaluated after 8 weeks of last injection session. All of the treatment sessions were performed on a day-case basis.. Eighty-five lesions have under gone 201 sclerotherapy sessions with 39 requiring one, 27 requiring two and 19 lesions requiring more than two sessions. Sclerotherapy with ethanolamine oleate provided complete resolution of symptoms in 79 lesions and significant improvement of 6 lesions. There is no recurrence of studied patients. All patients experienced pain and swelling to a variable degree for short duration. Skin sloughed out in four patients which were healed spontaneously. No other complications were observed in our study.. The treatment of VMs with injection ethanolamine oleate is safe and effective.

Topics: Adolescent; Child; Child, Preschool; Face; Female; Hemangioma, Cavernous; Humans; Infant; Male; Mouth; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Young Adult

Excision of intramuscular venous malformations may damage intact functional muscles, and sclerotherapy is an alternative way of relieving symptoms. Several sclerosants are available, but selection of the optimal one is controversial. We report our clinical experiences of sclerotherapy, and experimental studies in rats that investigated muscular damage after injection of various sclerosants. For the clinical study, 10 patients with intramuscular venous malformations were reviewed who had been treated by sclerotherapy using ethanolamine oleate. The rate by which the volume reduced was assessed quantitatively using findings from magnetic resonance imaging (MRI). Pain was cured or improved in all cases, and volume reduced on imaging analysis. There were no severe complications such as renal failure or thromboembolism. For the experimental study, 62 Wistar rats were used to investigate the toxicity of sclerosants on the intact-muscle by injecting three types of sclerosants (100% ethanol, 5% ethanolamine oleate, and 1% polidocanol). After the injection of each sclerosant into the anterior tibial muscle, the daily measurement of the circumference of the legs, histological and morphological alterations in the muscles, and maximal isometric tetanic tension, were investigated. Swelling was most prominent with ethanolamine oleate, while destruction and atrophy of the muscle were most prominent after injection of ethanol. In the clinical study, the efficacy of 5% ethanolamine oleate was at least equivalent or possibly superior to that of 100% ethanol. In the experimental study, ethanol had a more detrimental effect on muscles than the other agents. We consider that ethanolamine oleate is the most suitable sclerosant for the treatment of intramuscular venous malformations.

Topics: Adult; Animals; Female; Hemoglobinuria; Humans; Injections, Intramuscular; Isometric Contraction; Male; Muscle, Skeletal; Oleic Acids; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Veins

Topics: Adult; Capillaries; Combined Modality Therapy; Humans; Injections, Intradermal; Lasers; Lasers, Dye; Low-Level Light Therapy; Male; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Vascular Malformations

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

Venous malformations (VMs) involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult. Recently sclerotherapy has been suggested as the primary treatment for VMs instead of surgical intervention. This report represents eight cases of children with VMs treated with direct percutaneous injections of sclerosing agents, such as ethanol, polidocanol or ethanolamine oleate.. All eight patients had large lesions (>3 cm) located on the head, foot, neck and face. Sclerotherapy was performed in an angiographic suite under general anesthesia. Prior to sclerotherapy, percutaneous phlebography was performed in order to visualize the dynamic situation inside the lesion and the draining flow into the adjacent venous vascular system. A 2-15 ml of sclerosing agent was injected into VM lesions under fluoroscopy.. An evaluation by MRI examination showed that 6 out of 8 patients had remission, and alleviation of their symptoms without major complications, furthermore one of the lesions apparently disappeared. Intralesional sclerotherapy provides a simple, safe and effective treatment for VMs in the subcutaneous lesions in children.

Topics: Adolescent; Child; Child, Preschool; Ethanol; Female; Fluoroscopy; Humans; Injections, Intralesional; Magnetic Resonance Imaging; Male; Oleic Acids; Phlebography; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Veins