polidocanol and Leg-Ulcer

Compression sclerotherapy has been satisfactorily used for half a century for the treatment of varicose veins of the lower extremities. The effect of sclerosing solutions is that of making endofibrosis and vascular damage via producing endothelial injury. Different sclerosing agents were used by applying many different sclerotherapy methods. In recent years, sclerosing foam has been introduced in sclerotherapy with the goal of increasing the efficacy in the treatment of varicose veins. It is still uncertain whether foam or liquid form is superior. The aim of this study is to determine the efficacy and safety of the sclerosant polidocanol - which is a well-known detergent-type sclerosing agent - in foam form compared with liquid form.. A total of 100 women patients with telengiectases and small varicose veins of less than 4 mm were included in this study. The patients were divided into two groups according to presenting dates. Fifty patients who presented first were classified as the first group. They were treated with Tessari's foam sclerotherapy method. The second fifty patients who presented later were placed in the second group. They were treated with the liquid form of polidocanol. Extremity veins that did not have insufficiency at the saphenofemoral junction were divided into three groups as <1 mm, 1-2 mm and >2 but <4 mm, and the veins were treated with 0.25%, 0.5% or 1% of polidocanol, respectively. Clinical improvement, patients' complaints and side-effects were determined after treatment.. Complete disappearance was determined in 84% of patients in the foam form group and in 72% in the liquid form group. Although polidocanol in foam form's success rate was higher than the liquid form of polidocanol to clear the vessels, this result did not reach statistical significance (P = 0.148). There was no significant difference also in the side effects between each group.. Compression sclerotherapy is an effective and useful method for treating small varicose veins and telengiectases. Both polidocanol foam and polidocanol liquid forms are effective and safe sclerosing agents. The rates of side-effects were similar for both sclerotherapy methods. Although efficacy to clear the small varicose veins and telengiectases with foam polidocanol seems to be more successful than with liquid polidocanol, it is early to declare the superiority of the foam sclerotherapy method.

Topics: Adult; Dizziness; Dosage Forms; Ecchymosis; Female; Humans; Leg Ulcer; Male; Pharmaceutical Solutions; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Skin Pigmentation; Treatment Outcome; Varicose Veins; Vasculitis

Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating surgery) is only possible in a subset of patients with leg ulcers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments.. To evaluate the efficacy and safety of sclerosant in microfoam in treating venous leg ulceration.. A retrospective study of medical records, pretreatment and posttreatment color photographs, and echo Doppler in patients with venous leg ulceration. All patients were evaluated at 6 months after therapy, 70% were also evaluated at 2 years, 25% at 3 years, and 14% at 4 or more years after treatment. They were assessed for complete (100%) ulcer healing, time to wound closure, and recurrence.. Private vascular surgery clinic in Granada and dermatology department at a hospital in Pamplona, Spain.. Over 115 months, 116 consecutive patients (mean age [range], 57 [25-85] years) treated with ultrasound-guided injection of polidocanol microfoam (UIPM).. To reduce venous hypertension, UIPM was used to selectively and progressively sclerose sources of incompetence. The number of sessions per patient varied between 1 and 17 (mean, 3.6).. Complete ulcer healing, defined as full reepithelialization of the wound with absence of drainage. Recurrence was defined as epithelial breakdown in the healed limb.. At 6-months' follow-up, treatment with UIPM achieved complete healing in 83% of patients (96/116), with median time to healing of 2.7 months; 7 patients were never cured, and 1 patient was lost to follow-up. There were recurrences in 10 patients.. The use of UIPM to selectively and progressively sclerose incompetent veins produced by venous hypertension is highly effective to achieve a stable ulcer healing with minimal invasion, even in elderly patients. Recurrences are easily treatable with this approach. This technique may become a first-line treatment in the management of leg venous ulcers.

Topics: Adult; Aged; Aged, 80 and over; Chemistry, Pharmaceutical; Disease-Free Survival; Female; Humans; Injections, Intravenous; Leg Ulcer; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Treatment Outcome; Ultrasonography, Interventional; Wound Healing

High recurrence and high costs of treatment are the main problems with venous ulcer management. Therefore, it is of utmost importance to target the exact pathological cause. The role of cutaneous microvalves reflux in the pathogenesis of these ulcers has been confirmed. In this study, 20 chronic venous leg ulcers were prospectively subjected to foam sclerotherapy injection into periulcer veins using direct visualization by AccuVein AV400. Patients having infected ulcers, acute deep vein thrombosis, hypercoagulability, Ankle-Brachial Index <0.9, pregnancy, and/or allergy to the sclerosant were excluded. Endpoints included rates of ulcer size reduction, complete healing, ulcer recurrence, and procedure-related complications. Aethoxysklerol 1% was used in all cases to produce foam employing the double-syringe system. The mean reduction in ulcer surface area, postinjection, was 75% after 8 weeks and 91% after 12 weeks. Nineteen ulcers (95%) healed in a median time of 8 weeks, range 3 to 17 weeks. At 1 year of follow-up, 18 patients (90%) were still ulcer-free, while 1 patient's ulcer (5%) recurred 19 weeks postinjection. No major complications were encountered. Periulcer foam sclerotherapy injection, guided by vein visualization technology, should be one of the main lines of treatment of venous leg ulcers. It offers good results with regard to rapid ulcer healing and low recurrence rate without major risk. Randomized controlled trials are needed to establish these conclusions.

Topics: Chronic Disease; Female; Humans; Lasers; Leg Ulcer; Male; Middle Aged; Outcome and Process Assessment, Health Care; Polidocanol; Regional Blood Flow; Sclerosing Solutions; Sclerotherapy; Secondary Prevention; Varicose Ulcer; Veins; Wound Healing

This study measured patient outcomes among symptomatic patients with superficial chronic venous insufficiency who were treated with retrograde ultrasound-guided polidocanol microfoam 1% in a community setting.. Between March 2015 and June 2017, 250 symptomatic patients with C2-C6 chronic venous insufficiency received polidocanol microfoam 1% and were followed for 16 ± 7 months. Sixteen of the 250 patients (6.4%) had skin ulcers, and 56 (22.4%) were treated previously with thermal or surgical interventions. All patients underwent a duplex ultrasound venous incompetence study to map perforators and veins to be treated. Incompetent veins were accessed with a micropuncture needle distal to the midthigh perforator, approximately 10 cm above the knee fold. The leg was then elevated 45°. Under ultrasound guidance, the incompetent greater saphenous vein was closed with polidocanol microfoam 1%. A second injection was administered through the same catheter directing the microfoam to flow in a retrograde fashion through the incompetent venous valves to the ankle.. All patients completed the initial treatment; 55 (22.0%) required planned secondary treatment during the follow-up period for residual venous reflux in the below-knee greater saphenous vein. Complete elimination of venous valvular reflux and symptom improvement was documented in 236 patients (94.4%). Minor adverse events included asymptomatic deep vein thrombi (n = 2), common femoral vein thrombus extension (n = 1), and superficial venous thrombi (n = 4). Of the 16 patients with skin ulcers, 10 were C6 patients and 80% experienced wound closure within 4 weeks of treatment.. Retrograde administration of polidocanol microfoam 1% is a safe and effective treatment with important clinical benefit for superficial venous insufficiency in community practice.

Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Endovascular Procedures; Female; Humans; Leg Ulcer; Male; Middle Aged; Patient Satisfaction; Polidocanol; Polyethylene Glycols; Recovery of Function; Retreatment; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome; Ultrasonography, Interventional; Venous Insufficiency; Wound Healing

Topics: Aged, 80 and over; Female; Humans; Injections, Intralesional; Leg Ulcer; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Pyoderma Gangrenosum; Rheumatic Diseases; Sclerosing Solutions; Sclerotherapy; Ultrasonography, Doppler

Topics: Antiphospholipid Syndrome; Female; Humans; Leg; Leg Ulcer; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerotherapy; Telangiectasis

Thirty consecutive female patients with red leg telangiectasia less than 0.2 mm in diameter were treated with a Candela SPTL-1 Pulsed Dye Laser (PDL) tuned to 585 nm with a pulse duration of 450 microseconds at energies ranging from 6.0 to 8.5 J/cm2 delivered through a 5-mm spot size to the entire length of the telangiectasia. Seven patients with 25 patches of telangiectatic matting after previous sclerotherapy were also treated. Twenty-seven patients with symmetrical telangiectatic patches or a large "starburst" telangiectatic flair that could be divided into two separate treatment sites were treated at one site with PDL alone, and at the other site with a combination of PDL followed immediately by sclerotherapy (SCL) with Polidocanol 0.1-0.25 ml per injection site at a concentration of either 0.25%, 0.5%, or 0.75%. PDL treatment is efficacious for both essential telangiectasia and vessels that arise through the phenomena of telangiectatic matting. Sixty-five percent of vessels are completely faded with treatment. PDL alone has a remarkably low incidence of adverse sequelae. Treatment is most efficacious if all vessels larger than 0.2 mm in diameter, especially varicose and reticular feeding veins, are treated first. Treatment results are not affected by vessel location. And post-treatment compression of this type of vessel appears unnecessary. Combination PDL/SCL treatment appears to offer no advantage to sclerotherapy treatment alone and has a significant degree of complications when treatment is limited to red telangiectasia less than 0.2 mm in diameter with the laser parameters utilized.

Topics: Adult; Aged; Bandages; Combined Modality Therapy; Female; Humans; Laser Therapy; Leg; Leg Ulcer; Middle Aged; Pigmentation Disorders; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Telangiectasis