polidocanol and Foramen-Ovale--Patent

Sclerotherapy with polidocanol microfoam injection under duplex guidance is a new treatment for venous malformations associated with Klippel-Trenaunay syndrome. Multidetector-row computed tomography (MDCT) venography is extremely helpful in the assessment of disease extension and the planning of therapy. Observation In this particular case, MDCT venography demonstrated the origin, course, and relationship to adjacent anatomical structures of aberrant vessels that configure the superficial venous system with an anatomically normal and patent deep venous system. At the end of the treatment, which consisted of 8 sessions of microfoam sclerotherapy within 12 months, a considerable reduction in the number and size of the percutaneously treated aberrant veins was observed. The obvious clinical improvement was objectively demonstrated with MDCT venography, which showed clear reduction in the number and size of treated veins. Further clinical investigation performed because of isolated migraine episodes related to the sclerotherapy session revealed that the patient had a patent foramen ovale. A transcranial Doppler examination during the procedure showed middle cerebral artery bubbles, which indicated right-to-left shunt. No cerebral damage was observed in a subsequent diffusion-weighted magnetic resonance examination.. Microfoam sclerotherapy is an effective treatment option in patients with Klippel-Trenaunay syndrome. MDCT venography allows diagnosis of the disease, planning of therapy, and assessment of response to treatment. Although foam-induced microembolism is a common phenomenon during sclerotherapy, in this report we demonstrate that polidocanol microfoam prepared with a low-nitrogen gas mixture is safe in a patient with a patent foramen ovale.

Topics: Abnormalities, Multiple; Adult; Female; Follow-Up Studies; Foramen Ovale, Patent; Humans; Injections, Intravenous; Klippel-Trenaunay-Weber Syndrome; Phlebography; Polidocanol; Polyethylene Glycols; Risk Assessment; Sclerosing Solutions; Sclerotherapy; Severity of Illness Index; Time Factors; Treatment Outcome; Varicose Veins

Although foam sclerotherapy to varicose veins is now a popular treatment because of its high efficacy and safety, some neurologic complications have recently been reported. Presently, the effectiveness and safety of intravenous recombinant tissue-type plasminogen activator therapy to stroke following foam sclerotherapy remain unclear. Here, we report the case of a 68-year-old woman whose ischemic symptoms following foam sclerotherapy were treated by intravenous recombinant tissue-type plasminogen activator. After she was admitted, the venous thrombosis in her right soleus vein and a patent foramen ovale causing the right-to-left shunt were revealed. Thus, we diagnosed the ischemic symptoms were due to paradoxical embolism following foam sclerotherapy. After intravenous recombinant tissue-type plasminogen activator therapy, there was no complication and the outcome was good. Our case suggests the effectiveness and the safety of intravenous recombinant tissue-type plasminogen activator therapy to paradoxical embolism following foam sclerotherapy.

Topics: Administration, Intravenous; Aged; Embolism, Paradoxical; Female; Fibrinolytic Agents; Foramen Ovale, Patent; Humans; Polidocanol; Polyethylene Glycols; Recombinant Proteins; Sclerosing Solutions; Sclerotherapy; Stroke; Tissue Plasminogen Activator; Varicose Veins; Venous Thrombosis

Varicose veins are common and increasingly are being treated by less invasive endoscopic methods such as foam sclerotherapy. Patent foramen ovale (PFO) is also common, present in approximately one-quarter of adults. PFO allows bubbles introduced by foam sclerotherapy to cross into the general circulation, potentially causing cerebral artery gas embolization with unevaluated consequences.. Men and women aged 18 to 60 years with symptomatic varicose veins (CEAP C(3-5)) responded to an advertisement to recruit volunteers for a study on endovenous microfoam ablation (EMA). Participants' veins were screened by duplex ultrasound imaging, and those with isolated great saphenous vein (GSV) incompetence were tested for right-to-left (R-L) vascular shunt using transcranial Doppler (TCD) of the middle cerebral artery to detect the presence of bubble emboli after an injection of an agitated saline, blood, and air mixture as a contrast at rest and with the Valsalva maneuver.. Of 221 participants tested for R-L shunt, 85 (38.5%) were positive at rest (95% confidence interval [CI], 32.5-45.2) and 114 (51.8%) were positive after the Valsalva maneuver (95% CI, 45.4-58.5). A total 130 patients (58.8%) were positive for R-L shunt at rest or after Valsalva (95% CI, 52.5%-65.1%). This is significantly higher than the reported 26% prevalence of PFO in the general population (95% CI, 24.4-30.1).. The prevalence of R-L shunt in patients with GSV incompetence CEAP C(3-5) in this study was higher than expected in the general population. TCD does not differentiate between intracardiac shunts and intrapulmonary shunts, so this observation needs further investigation. This link between R-L shunt and varicose veins is novel and, whether etiologic or functional, may improve the understanding of both conditions. The findings have importance in the treatment of varicose veins with foam sclerotherapy and EMA.

Topics: Adult; Coronary Circulation; England; Female; Foramen Ovale, Patent; Humans; Intracranial Embolism; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prevalence; Pulmonary Circulation; Regional Blood Flow; Saphenous Vein; Sclerosing Solutions; Sclerotherapy; Severity of Illness Index; Ultrasonography, Doppler, Duplex; Ultrasonography, Doppler, Transcranial; United States; Valsalva Maneuver; Varicose Veins; Venous Insufficiency; Young Adult

A 37-year-old male was treated with 9 ml of 3% polidocanol foam, and he immediately reported photopsiae lasting a few minutes, though without migraine. Two hours after sclerotherapy, the patient developed speech disturbance for a few minutes. A pathological examination revealed nothing except a patent foramen ovale (PFO). Given the contrast between the high prevalence of PFO in general population and the extremely low incidence of neurological deficits after foam sclerotherapy, these deficits may only arise due to as-yet-unknown aetiology.

Topics: Adult; Foramen Ovale, Patent; Humans; Male; Polidocanol; Polyethylene Glycols; Risk Factors; Sclerosing Solutions; Sclerotherapy; Speech Disorders; Stockings, Compression; Ultrasonography, Doppler, Duplex; Ultrasonography, Interventional; Varicose Veins; Vision Disorders

Topics: Embolism, Air; Foramen Ovale, Patent; Heart Diseases; Humans; Intracranial Embolism; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Varicose Veins