polidocanol and Embolism

The objective of the study was to review the literature reporting visual disturbance (VD)following sclerotherapy for varicose veins. Underlying mechanisms will be discussed. A literature search of the databases Medline and Google Scholar was performed. Original articles including randomized trials, case series and case reports reporting VD in humans following sclerotherapy for varicose veins were included. Additional references were also obtained if they had been referenced in related publications. The search yielded 4948 results of which 25 reports were found to meet the inclusion criteria. In larger series with at least 500 included patients the prevalence of VD following sclerotherapy ranges from 0.09% to 2%. In most reports foam sclerotherapy was associated with VD (19); exclusive use of liquid sclerosant was reported in two cases, some reports included foam and liquid sclerosant (4). There were no persistent visual disorders reported. VD occurred with polidocanol and sodium tetradecyl sulphate in different concentrations (0.25–3%). Various forms of foam preparation including various ways of foam production and the liquid –air ratio (1 or 2 parts of liquid mixed with 3, 4 or 5 parts of air) were reported in association with the occurrence of VD. VDs following sclerotherapy for varicose veins are rare and all reported events were transient. Bubble embolism or any kind of embolism seems unlikely to be the only underlying mechanism. A systemic inflammatory response following sclerotherapy has been suggested. Further research to clarify the mechanism of action of sclerosants is required.

Topics: Embolism; Female; Humans; Male; MEDLINE; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate; Telangiectasis; Varicose Veins; Vision Disorders

Foam sclerotherapy is a safe, effective and increasingly widespread method of treating varicose veins. A case of ischemic stroke is described with reversible symptoms five days after polidocanol foam sclerotherapy was repeated in a 48-year-old female patient with a patent foramen ovale that was undetected at the time of sclerotherapy. The first foam sclerotherapy treatment had been tolerated well without complications. While acute neurological events immediately after sclerotherapy for varicose veins have been described repeatedly in the literature, this report is only the third case described worldwide of paradoxical embolism as a possible late complication of foam sclerotherapy for varicose veins.

Topics: Embolism; Female; Humans; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerotherapy; Stroke; Tissue Adhesives; Ultrasonography; Varicose Veins; Venous Insufficiency

Embolia cutis medicamentosa (Nicolau Syndrome) is a very rare complication of intramuscular injections which presents with extensive necrosis of the injected skin area. Intra-arteria and/or para-arterial injections after prior perforation of certain vessels are discussed as possible pathogenetic mechanisms. We describe the occurrence of embolia cutis medicamentosa after intra-articular injections into the knee.

Topics: Anti-Inflammatory Agents; Embolism; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Necrosis; Polidocanol; Polyethylene Glycols; Prednisolone; Sclerosing Solutions; Skin; Syndrome