polidocanol and Arteriovenous-Malformations

To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy's lesion.. One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy's lesion were treated with three endoscopic hemostasis methods: aethoxysklerol injection (46 cases), endoscopic hemoclip hemostasis (31 cases), and a combination of hemoclip hemostasis with aethoxysklerol injection (30 cases).. The rates of successful hemostasis using the three methods were 71.7% (33/46), 77.4% (24/31) and 96.7% (29/30), respectively, with significant differences between the methods (P < 0.05). Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis, 7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aethoxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no re-bleeding was found during a 1-year follow-up.. The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy's lesion.

Topics: Adult; Aged; Arteriovenous Malformations; Endoscopy; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols

To evaluate the efficacy of sclerotherapy for congenital vascular malformation (CVM) using a combination of polidocanol foam and bleomycin liquid.. A retrospective review of a prospectively collected data on patients who had sclerotherapy for CVM from May 2015 to July 2022 was performed.. A total of 210 patients with a mean age of 24.8 ± 2.0 years were included. Venous malformation (VM) was the most common type of CVM, accounting for 81.9% (172/210) of all patients. At 6 months follow-up, the overall clinical effective rate was 93.3% (196/210), and 50% (105/210) of patients were clinically cured. The clinical effective rates in VM, lymphatic, and arteriovenous malformation group were 94.2%, 100%, and 100%.. Sclerotherapy using a combination of polidocanol foam and bleomycin liquid is an effective and safe treatment for venous and lymphatic malformations. It is a promising treatment option with satisfactory clinical outcome in arteriovenous malformations.

Topics: Adult; Arteriovenous Malformations; Bleomycin; Humans; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations; Young Adult

Arteriovenous malformation (AVM) sometimes causes hemorrhage that can be fatal. We report a case of AVM of the tongue with bleeding that was treated by semi-emergent sclerotherapy with polidocanol. A 33-year-old woman presented with Schobinger stage III AVM of the tongue. Sclerotherapy with 3% polidocanol foam was performed under general anesthesia using curved intestinal forceps to clamp the root of the tongue for control of blood flow. Postoperatively, there was no further bleeding from the lesion. Three subsequent sclerotherapy sessions with polidocanol were performed, and there was a marked reduction in the size of the lesion. The lesion has remained well controlled in the year since the last sclerotherapy session.

Topics: Adult; Arteriovenous Malformations; Female; Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Surgical Instruments; Tongue; Treatment Outcome

This study reports our experience, the therapeutic outcomes and complications of percutaneous sclerotherapy (PS) with polidocanol to treat venous malformations (VMs) in children.A retrospective analysis was conducted of pediatric patients with VMs who underwent PS using polidocanol under continuous ultrasound (US) guidance between January 2015 and January 2018 at our department. Medical records were reviewed to record demographic information, lesion characteristics, treatment sessions, therapeutic outcomes and complications. χ analysis was employed to evaluate the effects of these characteristics on outcomes.Hundred treatment sessions were performed for lesions in 47 patients. The mean age of the patients was 4.1 ± 3.6 years (mean ± SD). The female to male ratio was almost 2:1 (female 32, male 15). The location of the VMs included the head and neck in 16 cases (34.0%), upper extremity in 11 cases (23.4%), lower extremity in 10 cases (21.3%), and trunk and perineum in 10 cases (21.3%). The majority of the lesions were focal in 36 cases (76.6%), while 11 (23.4%) were diffuse. Seventeen patients (36.2%) underwent single PS session, 14 patients (29.8%) underwent 2 sessions, 10 patients (21.3%) underwent 3 sessions and 6 patients (12.7%) underwent ≧4 sessions. The mean PS session per patient was 2.1 ± 1.1. The mean follow-up duration was 11.4 ± 7.6 months. After the last PS session, 8 patients (17.0%) had excellent outcomes, 27 (57.4%) had good outcomes, 10 (21.3%) had fair outcomes, and 2 (4.3%) had poor outcomes. Focal lesions were more likely to have good or excellent outcomes than diffuse lesions (χ = 4.522, P = .033). No other lesion characteristic significantly affected the outcomes (good or excellent outcomes), including lesion location (χ = 2.011, P = .570) or lesion size (χ = 1.045, P = .307). After the PS procedure, temporary local swelling occurred in 81 sessions (81.0%), local pain occurred in 15 sessions (15.0%), fever occurred in 27 (27.0%) sessions, and transient local numbness occurred in four sessions (4.0%).PS with polidocanol under the guidance of US appears to be safe and effective for the treatment of VMs in children, especially for focal lesions.

Topics: Arteriovenous Malformations; Child; Child, Preschool; Female; Humans; Infant; Male; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Ultrasonography, Interventional

To assess the safety and effectiveness of polidocanol sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs).. Twenty-three patients with symptomatic AVMs in the head and neck (6), upper (7) and lower extremity (10) with a mean age of 42 years (range 4-74) treated with polidocanol sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 2 type I, 6 type II, 6 type IIIa and 9 type IIIb. Arterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. Polidocanol mixed with contrast material or carbon dioxide was delivered by percutaneous direct puncture.. Treatment was successfully performed in all patients. In the mean follow-up period of 38 months, symptoms resolved or improved in 20/23 patients (87.0%). AVMs were devascularized 100% in 2 patients, 76-99% in 13, 50-75% in 7 and < 50% in 1. More than 50% devascularization was seen in 22 patients (95.6%). Two (8%) patients had complete remission, 17 (74%) had partial remission and 3 (13%) had no remission. There was no aggravation. Treatment was considered effective (complete and partial remission) in 20 patients (87.0%). Minor complications including localized arterial thrombosis (2) and spontaneously healing skin ulcer (1) were seen in 2 patients (8.7%). There were no major procedure-related complications.. Polidocanol 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; Arteriovenous Malformations; Child; Child, Preschool; Embolization, Therapeutic; Enbucrilate; Female; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Young Adult

Foam sclerotherapy is an effective treatment strategy for varicose veins and venous malformations. Foam stability varies according to foam composition, volume, and injection technique.. To evaluate the stability of polidocanol (POL) foam with the addition of hyaluronic acid (HA).. Group A: 2 mL of 1% POL + 0 mL of 1% HA + 8 mL of air; Group B: 2 mL of 1% POL + 0.05 mL of 1% HA + 8 mL of air; Group C: 2 mL of 1% POL + 0.1 mL of 1% HA + 8 mL of air. Tessari's method was used for foam generation. The half-life, or the time for a volume of foam to be reduced to half of its original volume, was used to evaluate foam stability. Five recordings were made for each group.. The half-life was 142.8 (±4.32) seconds for 1% POL without the addition of HA, 310.6 (±7.53) seconds with the addition of 0.05 mL of 1% HA, and 390.4 (±13.06) seconds with the addition of 0.1 mL of 1% HA.. The stability of POL foam was highly increased by the addition of small amounts of HA.

Topics: Arteriovenous Malformations; Drug Stability; Half-Life; Humans; Hyaluronic Acid; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Varicose Veins

The purpose of this study was to investigate the efficacy and safety of intraarterial transcatheter administration of polidocanol as an alternative treatment for peripheral arteriovenous malformations (AVMs).. The study comprised 10 patients (six males and four females) with a mean age of 28.8 years (range 8-52 years). All patients had trunk or extremity AVMs. Following the administration of general anesthesia or intravenous (IV) sedation, the patients underwent staged intraarterial polidocanol sclerotherapy with or without additional embolizations for their AVMs. The administration of polidocanol was executed by intraarterial infusion through a microcatheter or by direct percutaneous entry into the nidus under ultrasound guidance.. A total of 19 sessions were accomplished in 10 patients. Polidocanol was used alone in six of the 19 sessions. In 13 sessions, polidocanol was used in combination with another agent (including n-butyl cyanoacrylate (NBCA), lipiodol, and ethanol) and/or coils. In two sessions, polidocanol was administered percutaneously under ultrasound guidance directly into the nidus documented by arteriography. No major complications occurred.. Intraarterial transcatheter administration of polidocanol alone or in combination with other agents is a safe and effective alternative treatment for peripheral AVMs.

Topics: Adolescent; Adult; Arteriovenous Malformations; Bucrylate; Child; Female; Humans; Injections, Intra-Arterial; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerotherapy; Tissue Adhesives; 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

Topics: Argon Plasma Coagulation; Arterioles; Arteriovenous Malformations; Duodenum; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hemostasis, Endoscopic; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Treatment Outcome; Young Adult

Venous angiomata, or venous malformations, are often present at birth, although they may not be evident until later. They consist of a spongy tangle of veins, and these lesions usually vary in size. Treatment of venous angiomata is often requested for cosmetic reasons, but painful ulcerations, nerve compression, functional disability can command care. This presentation describes management using sclerosant foam as the treating agent. During a 30-month period ending March 2004, 1,321 patients were investigated for venous disorders at the Vein Institute of La Jolla. Fourteen (incidence 1%) were found to have venous angiomata (: nine women). The age range was 15-76 years (mean 30.8 +/- 18.6). Lesions were classified by the Hamburg system and were primarily venous, extratruncular in 12 patients and combined extratruncular and truncular in two patients. Eight patients, three males, had manifestations of lower extremity Klippel-Trenaunay (syndrome; six had only venous angiomas. Only 10 of the 14 patients were treated. All patients were studied by Doppler duplex examination. Selected lesions were chosen for helical computed tomographic studies. Magnetic resonance venography was also used to image the lesions, define the deep circulation, note connections with normal circulation, identify vessels for therapeutic access, and determine infiltration of the lesion into adjacent soft tissue. Foam was produced by the Tessari two syringes one three-way stopcock teclinique, with the air to Polidocanol ratio being 4 or 5 to 1. This was used at 1% or 2% concentration, specific for each patient. The SonoSite 190 plus Duplex Doppler was used for ultrasound guidance, whenever deep access was required and to monitor progress and effects of treatment. A goal was set for each patient before treatment was begun. Ten patients were treated, and four await treatment. The mean number of treatments was 3.6 +/- 2.8 (range 1-10). A primary goal of pain-free healing was set in patients with nonhealing, painful ulceration or symptomatic varicose veins. This was achieved in all treated patients. Cosmetically, all of the patients were improved, and symptomatic patients were relieved of pain. The single complication was formation of a cutaneous ulcer following injection of telangiectasias. Sclerosant foam is a satisfactory tool to use in treating venous angiomata including the Klippel-Trenaunay syndrome. Use of foam sclerotherapy in this experience has proven the technique to be effective, e

Topics: Adolescent; Adult; Aged; Angiomatosis; Arteriovenous Malformations; Diagnostic Imaging; Female; Humans; Klippel-Trenaunay-Weber Syndrome; Magnetic Resonance Imaging; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Ultrasonography, Doppler, Duplex

The aim of this prospective study was to assess the safety and efficacy of sonographically guided percutaneous injection of 1% polidocanol for sclerosis of peripheral vascular malformations.. Patients with vascular malformations of soft tissues were invited to enroll in the study. Gray-scale and color Doppler sonography were performed to determine the texture, margins, and size of the lesions and to determine whether high-velocity blood flow was present. Using real-time sonographic guidance, lesions were punctured with a 20/21-gauge spinal needle. When possible, venous return was occluded before injection. For each injection, 1-6 ml of 1% polidocanol was injected into 1 or more sites within the lesion. The sclerosing agent was not aspirated after injection. Repeat radiography was performed 1 month after each injection session. The procedure was repeated if the patient did not have a complete response, defined as an 80% or greater decrease in the volume of the lesion or resolution of the presenting symptoms.. Of the 15 patients enrolled, 9 had venous malformations, 3 had lymphangiomas, 1 had a recurrent aneurysmal bone cyst, 1 had a venous pseudoaneurysm, and 1 had an arteriovenous malformation of the pinna. Each patient received 1-20 injections of 1% polidocanol (mean +/- standard deviation, 3.3 +/- 4.8 injections). This treatment resulted in a complete response of 7 venous malformations, 3 lymphangiomas, and the arteriovenous malformation and partial response of 2 venous malformations, the recurrent aneurysmal bone cyst, and the venous pseudoaneurysm. Only minor complications occurred.. Sonographically guided percutaneous injection of 1% polidocanol for sclerosis of peripheral vascular lesions is simple, effective, and safe. This technique is especially effective in cases of soft tissue venous malformation and lymphangioma.

Topics: Adolescent; Adult; Arteriovenous Malformations; Child; Extremities; Humans; Injections, Intralesional; Lymphangioma; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Ultrasonography, Doppler, Color; Ultrasonography, Interventional; Veins

Polidocanol sclerotherapy is a well-established therapeutic modality for the treatment of venous malformations. Systemic complications are extremely rare.. To report a case of cardiac complication after polidocanol injection of peripheral venous malformation.. A case report and a review of the English language literature using a published MEDLINE search strategy.. A patient undergoing polidocanol sclerotherapy for a symptomatic venous malformation of the right inferior limb developed cardiac arrest shortly after injection of the sclerosing agent which was promptly reversed.. Systemic complications following sclerotherapy may occur even when the sclerosant is injected in peripheral veins or venous malformations. Clinicians should be alerted to the possibility of uncommon but life-threatening adverse effects.

Topics: Arteriovenous Malformations; Cardiopulmonary Resuscitation; Child, Preschool; Diagnosis, Differential; Heart Arrest; Humans; Iliac Vein; Leg; Pain; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Ultrasonography

Although surgical extirpation is the standard method for the treatment of vascular malformations, this procedure often leads to loss of motor function, nerve damage, and massive bleeding if the excision is extensive. Sclerotherapy is an alternative method of treatment for venous malformations.. This study was conducted to assess the effect of color duplex ultrasound-guided sclerotherapy on venous malformations and the coagulability induced by sclerosing solution.. Twenty-eight patients with venous malformations underwent percutaneous sclerotherapy by direct puncture under duplex ultrasound guidance. Intravenous catheters were inserted into duplex ultrasound-confirmed venous spaces and fine plastic tubing filled with normal saline was attached to the needle. When the needle tip was observed to pierce the vein wall, aspiration of the blood confirmed its intraluminal position. The mean volume of 3.6 ml of 3% polidocanol was injected. Subfascial ligation of the lateral marginal venous collector was performed in patients with Klippel-Trenaunay syndrome. D-dimer (DD) and thrombin-antithrombin III (TAT) were measured preoperatively and on the first and fifth postoperative days.. The head and neck, which was the most common site of venous malformations were involved in 57% of the patients. Venous malformations disappeared in 44% of the patients and decreased in 28%. Localized pain was the most common complication, occuring in 82% of the patients. Sclerotherapy for venous malformations produced significant swelling in 75% of the patients, which required 5-7 days to subside. Significant differences were detected in both DD and TAT concentrations on the first and fifth postoperative days.. Color duplex-guided sclerotherapy was effective in 82% of the patients. This procedure prevents intra-arterial injection accidents. Although patients with venous malformations showed greater coagulability, no serious thrombotic sequelae were found.

Topics: Adolescent; Adult; Arteriovenous Malformations; Child; Child, Preschool; Female; Humans; Klippel-Trenaunay-Weber Syndrome; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Ultrasonography, Doppler, Color; Ultrasonography, Interventional; Veins

In 19 of 532 consecutive patients with intestinal bleeding, 47 vascular malformations were found endoscopically as the source of the hemorrhage (3.6%). Eleven angiodysplasias were located in the gastroduodenum and 36 in the colorectum. In all patients, bleeding had stopped spontaneously before endoscopy was performed. To detect superficial arterial vessels responsible for the hemorrhage all lesions were scanned by transendoscopic Doppler ultrasound. There were 41 Doppler-positive anomalies (87%) and 6 Doppler-negative anomalies without an arterial signal. All malformations with submucosal arterial blood flow were treated by prophylactic injection therapy. Control Doppler ultrasound two weeks later revealed the presence of a vessel in 4 angiodysplasias followed by a second sclerotherapy. The 6 Doppler negative lesions could not be found on control examination and corresponded probably to temporary traumatic or inflammatory mucosal changes. Within the framework of follow-up over three months, 2 patients rebled (10.5%). A second sclerotherapy resulted in no further hemorrhage. Endoscopic Doppler ultrasound may help in identification and treatment of gastrointestinal angiodysplasias. After identification of blood vessels responsible for hemorrhage, Doppler ultrasound enables monitoring of local endoscopic therapy.

Topics: Adult; Aged; Arteriovenous Malformations; Digestive System; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Ultrasonics; Ultrasonography