polidocanol and Necrosis

We delineate the role of phlebography which is a standard procedure during antegrade and retrograde sclerotherapy of idiopathic varicoceles.. Based on our experience with antegrade sclerotherapy in 5,254 adults and adolescents we present typical phlebographies of the internal spermatic vein and radiological images after irregular cannulation of different arteries and veins on the scrotal floor. The sequalae of misinjections and paravascular application of the sclerosing agent polidocanol are discussed. A radiological classification of venous drainage roots of the pampiniform plexus is introduced on the basis of 236 consecutive antegrade phlebographies. The findings are compared with the results of retrograde phlebography previously given in literature.. Phlebography helps to ascertain that sclerotherapy is performed in an anatomically appropriate manner. Thus, misinjections and paravascular applications of polidocanol can be ruled out. Antegrade phlebography enables to visualize a high rate of side veins and collaterals of the internal spermatic vein and thus seems to be equivalent to the retrograde imaging in tracing the additional drainage roots of the pampiniform plexus. These additional roots are considered to be the source of persisting varicoceles after surgical treatment.. Phlebography is needed to achieve good results after sclerotherapy of varicoceles and to minimize the toxic side effects of polidocanol. Finally it is a prove that the treatment has been performed accurately for forensic reasons.

Topics: Abdominal Wall; Catheterization; Clinical Protocols; Humans; Male; Malpractice; Necrosis; Phlebography; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Spermatic Cord; Varicocele; Veins

Topics: Adult; Face; Female; Humans; Necrosis; Polidocanol; Scalp; Sclerosing Solutions; Sclerotherapy; Skin Diseases; Vascular Malformations

The objective was to investigate the effects of the detergent sclerosants sodium tetradecyl sulfate (STS) and polidocanol (POL) on human leukocytes at sublytic concentrations.. Leukocytes were isolated and labelled with antibodies to assess for apoptosis and examined with confocal microscopy and flow cytometry. Isolated leukocyte count and viability was assessed using trypan blue, and propidium iodide staining. Phosphatidylserine (PS) exposure, a universal hallmark to measure cell apoptosis, was identified by flow cytometry using lactadherin. Caspases 3, 8, and 9, and Bax activation, as well as inhibitory assays with pan-caspase (Z-VAD-FMK) and Bax (BI-6C9) were assessed to determine apoptotic pathways. Porimin activation was used to assess cell permeability.. Up to 40% of leukocytes maintained membrane integrity at sublytic concentrations (≤0.15%) of sclerosants. The remaining 60% did not maintain membrane integrity but were not completely lysed. PS exposure was increased with both STS and POL exhibiting a dose- and time-dependant trend. While activation of caspases 3, 8, and 9, as well as Bax activation, were increased in leukocytes stimulated with low concentrations of STS, only caspases 3 and 9 and Bax were increased with POL. Inhibitory assays demonstrated caspases 3, 8, and 9, and Bax inhibition at low concentrations with both STS and POL. Both agents increased the leukocyte activation of porimin at all concentrations. On confocal microscopy, stains for caspases 3, 8, and 9, and Bax were increased for both STS and POL. Porimin stain was markedly positive for both STS and POL.. Both sclerosants induced leukocyte apoptosis at sublytic concentrations. STS activated both extrinsic and intrinsic pathways of apoptosis, while POL stimulated the intrinsic pathway of apoptosis only. Both agents induced oncosis. Based on these results, STS appears to have a greater effect than POL.

Topics: Apoptosis; Caspases; Detergents; Humans; Leukocytes; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sodium Tetradecyl Sulfate

A 23-year-old woman developed painful skin necrosis after injections with lauromacrogol 400 for varicose veins. This complication, called embolia cutis medicamentosa or Nicolau syndrome, is characterised by acute pain and necrosis of the skin, subcutaneous tissue and muscle. Surgical intervention by local excision seems to be the best therapy.

Topics: Drug Eruptions; Female; Humans; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Skin; Skin Diseases; Varicose Veins

Foam sclerosants are widely used in sclerotherapy and have been accepted as more effective than the liquid form; however, there is no consensus about the most applicable and effective concentration.. The aim of this study was to investigate the histopathological changes caused by various widely used concentrations of foam sclerosant.. Fifty-six varicose vein segments of 5-10 mm diameter were gently resected and exposed to various concentrations of foam sclerosant (0.5%, 1%, 2%, 3%) for 5 min, and were then prepared for routine histopathological examination. A total damage scoring system, including the presence of endothelial swelling, intimal thickening, cellular vacuolization in the muscle layer, edema in the tunica media and extent of necrosis, was established.. The total damage score of the foam sclerosant groups was significantly higher than that of the control group (median 2.75 vs 1, p = 0.007). The highest damage score was achieved by 1% and 2% foam sclerosants (3.5 and 2.5). No significant difference was found among the different concentrations of sclerosant, although the 1% group caused more severe damage at a near significant level (p = 0.074).. Significant pathological damage can be caused by even the lowest doses of foam sclerosant. The most injurious concentrations were found to be 1% and 2%, morphologically. A working concentration of 1% could thus be preferable to 0.5%, especially in larger veins. Further in-vivo studies are needed in order to validate these findings.

Topics: Dose-Response Relationship, Drug; Humans; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Varicose Veins; Veins

Cutaneous necrosis is one of the most annoying complications of reticular and spider vein sclerotherapy. The precise incidence of the complication is not known, although various sources reported incidence between 0.2% and 1.2%. Among a few mechanisms proposed to explain it, extravasation of the sclerosant into the perivascular tissue has been cited as the major cause.. The aim of the experimental study in rats was to examine the potential of various concentrations and volumes of polidocanol in both liquid and foam forms to cause cutaneous necrosis after superficial subcutaneous injection.. Twenty-four female Sprague Dawley rats were injected subcutaneously different concentrations (0.5%, 1%, 2% and 3%) of polidocanol as well as different preparations of polidocanol (liquid vs. foam) and volumes (0.1-0.5 mL). The animals were sacrificed 10 days after injections and biopsy specimens were obtained.. Cutaneous necrosis was not seen at volumes <0.5 mL regardless of the concentration or form of polidocanol injected. Foam preparation was shown to be less potent in inducing necrosis with a minimal strength being 2% in comparison with the liquid form where 1% was sufficient to produce overt cutaneous necrosis.. This experimental study shows that extravasation of polidocal in usual circumstances of sclerotherapy of spider and reticular veins cannot be a significant cause of cutaneous necrosis rarely observed in this setting. It is particularly true for the foamed polidocanol where 1% strength seems safe if injected extravascularly in volumes up to 0.5 mL.

Topics: Animals; Extravasation of Diagnostic and Therapeutic Materials; Female; Injections, Subcutaneous; Necrosis; Polidocanol; Polyethylene Glycols; Rats; Rats, Sprague-Dawley; Sclerosing Solutions; Sclerotherapy; Skin; Telangiectasis

Topics: Drug Approval; Humans; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate; United States; United States Food and Drug Administration; Varicose Veins

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

A cutaneous hemangioma of the penis extending from the proximal portion of the glans to the prepuce of an 18-year-old man was successfully treated by sclerotherapy with polidocanol and interrupted ligation of the hemangioma.

Topics: Adolescent; Hemangioma; Humans; Ligation; Male; Necrosis; Penile Neoplasms; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Skin

A 43-year-old man with a gastric ulcer was admitted because of sudden onset of epigastric pain, cold sweats and dizziness. He had tachycardia (100/min); his blood pressure was 120/80 mm Hg: his epigastrium was tender to palpation. There were no tarry stools.. Haemoglobin concentration was 12.7 g/dl. WBC count 17,900/microliter. Gastroscopy revealed residual haematin and an ulcer with an arterial stump at the angular fold.. 3 ml epinephrine, diluted 1:20,000, and 13 ml of 1% polidocanol were injected around the arterial stump, most of the latter solution flowing back into the gastric lumen from the rather hard ulcer base. Haematemesis four days later necessitated laparotomy followed by gastrectomy with reconstruction and a Roux-Y anastomosis because of complete necrosis of the gastric wall. Histological examination of the surgical specimen showed chronic scarred gastric ulcer and ulcerating pangastritis with haemorrhagic necrosis of the wall and associated peritonitis, caused by accidental injection of polidocanol into the artery.. Since the tissue-sparing injection of epinephrine, fibrin glue or salt solution is alone effective in the endoscopic treatment of bleeding gastroduodenal ulcers, polidocanol should not be injected as well.

Topics: Adult; Anastomosis, Roux-en-Y; Epinephrine; Gastrectomy; Gastroscopy; Hematemesis; Humans; Injections, Intralesional; Male; Necrosis; Peritonitis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach; Stomach Ulcer

Topics: Humans; Male; Middle Aged; Necrosis; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer

Topics: Duodenal Ulcer; Endoscopy, Gastrointestinal; Gastric Mucosa; Humans; Male; Middle Aged; Necrosis; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Polidocanol; Polyethylene Glycols; Sclerotherapy

Topics: Duodenal Ulcer; Gastric Mucosa; Humans; Male; Middle Aged; Necrosis; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Aged; Aged, 80 and over; Epinephrine; Humans; Male; Necrosis; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Stomach

Polidocanol is a widely used sclerosing agent that was first developed as a local anesthetic. In France it is used in varicose veins as well as in telangiectases.. To improve the knowledge of the effects of polidocanol and provide recommendations for better use.. Based on 12 years of experience in treating nearly 11,000 patients with polidocanol, the author reviews his observations. A theoretical model of dilution of sclerosing agents in injected veins is provided.. The author observed: seven cases of minor urticaria, occurrence of grey veil when used under the air-block technique, one case of cutaneous necrosis (5 cm3), and some small epidermic necrosis (1-mm diameter) and neither shock nor severe adverse reaction.. Polidocanol is characterized by its spasmogenic action on veins, excellent local tolerance, and a very low incidence of general reactions. Low concentrations (0.3 to 0.6%) can be used for the treatment of quite large varicose veins if an adequate volume is injected.

Topics: Adult; Female; Humans; Male; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Skin; Urticaria; Varicose Veins

Previous studies detailing the clinical and histologic effects of sclerosing solutions in rabbit ear and other animal vein models have provided information comparing the effects of various concentrations of hypertonic saline with and without dextrose (Sclerodex), polidocanol, scleremo (chromated glycerin), and sodium tetradecyl sulfate.. To observe short-term histologic changes of sclerosing solutions in vitro in large diameter human vein.. Human saphenous vein segments were obtained following cardiac bypass procedures. Several types of sclerosing solutions, including 23.4% hypertonic saline, 1% polidocanol, and 3% sodium tetradecyl sulfate, were allowed continuous contact with the vessel wall for 10 minutes. Test vein segments were immediately fixed and observed for histologic changes compared with normal saline controls.. Endothelium was rapidly destroyed by all tested sclerosing solutions. Vessel wall necrosis occurred quickly with the extent determined by the sclerosing solution. Destructive potential of 3% sodium tetradecyl sulfate greatly exceeded that of 23.4% hypertonic saline or 1% polidocanol, in agreement with previous animal studies.. Direct toxic effects of sclerosing agents may be compared in a constant, reproducible environment with this in vitro model.

Topics: Endothelium, Vascular; Humans; Necrosis; Polidocanol; Polyethylene Glycols; Saline Solution, Hypertonic; Saphenous Vein; Sclerosing Solutions; Sodium Chloride; Sodium Tetradecyl Sulfate; Tunica Intima

This paper reports on a patient who was treated by percutaneous aspiration, instillation of a sclerosant (polidocanol) and cystogastric drainage for a post-acute pancreatic pseudocyst. Five weeks after admission to hospital for the first episode of an acute necrotizing pancreatitis, the 60-year-old man underwent a percutaneous, ultrasound-guided puncture and aspiration of a voluminous pancreatic pseudocyst. Ten days later, recurrent fluid collection led to a second puncture, combined with the injection of polidocanol (15 ml; 1%) into the cyst cavity. Since this treatment failed, a percutaneous cystogastric drain ("double--pigtail") was inserted five days later. After developing acute abdominal pain and incipient sepsis, the patient was sent for surgical intervention twelve days after the second treatment with percutaneous aspiration and injection of polidocanol. During the operation an infected pancreatic pseudocyst with extensive contaminated necrosis of the pancreas and duodenal perforation was found. Necrectomy was performed, followed by continuous lavage of the omental bursa. Intensive care therapy was necessary for one week. Duodenal leakage persisted for nearly three weeks, the stopped spontaneously. The patient was discharged in quite a good state of health after 33 days of postoperative treatment. Although spontaneous development of infected pancreatic pseudocysts and pancreatic abscesses in necrotizing pancreatitis is known, a possible involvement of the drainage procedures, especially in combination with the injection of a sclerosant must be considered.

Topics: Bacterial Infections; Drainage; Humans; Male; Middle Aged; Necrosis; Pancreas; Pancreatic Pseudocyst; Pancreatitis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Suction

A 0.25-mL quantity of 0.25%, 0.5%, and 1.0% polidocanol (Aethoxysclerol [France]), 0.5% sodium tetradecyl sulfate (Sotradecol injection), and 23.4% hypertonic saline was injected into the dorsal marginal rabbit ear vein; clinical and histologic thrombosis resulted that lasted between four and eight days. The lowest concentration of polidocanol (0.25%) demonstrated immediate thrombosis; however, no clinical or histologic changes occurred eight days after injection. With all other agents, histologic fibrosis of the vessel correlating with clinical disappearance occurred after eight days. However, 0.5% polidocanol and sodium tetradecyl sulfate developed recanalization through the initially sclerosed vessel between eight and 14 days, with clinical reappearance of the 0.5% polidocanol-injected vessel at 30 days, after injection. Cutaneous necrosis was noted clinically and histologically in three of ten vessels injected with 1.0% polidocanol and in two of ten vessels injected with hypertonic saline. Clinical and histologic evidence of necrosis occurred with and without extravasation of the sclerosants.

Topics: Animals; Ear; Fatty Alcohols; Injections, Intravenous; Necrosis; Polidocanol; Polyethylene Glycols; Rabbits; Saline Solution, Hypertonic; Sodium Chloride; Sodium Tetradecyl Sulfate; Telangiectasis; Veins

The sclerosing effect of injections of ethoxysklerol, phenol-almondoil, and 10% NaCl-solution into the esophageal walls of 64 wistar-rats was histologically investigated after 2 days, 1 week, 3 weeks, and 4 months. Inflammatory reaction and subsequent sclerosis were of the same kind with all substances. Nevertheless ethoxysklerol showed a slight dependence on concentration. Injection of phenol-almondoil resulted in a less diffuse inflammation than the aqueous solutions. But after 4 months all cases exhibited the same patchy sclerosis despite of the solution used. Our findings and those of the literature allow the conclusion that the sclerosing effect is less dependent from the inflammation-inducing substance itself but from its concentration and localization.

Topics: Animals; Collagen; Dose-Response Relationship, Drug; Esophagitis; Esophagus; Male; Necrosis; Phenols; Plant Oils; Polidocanol; Polyethylene Glycols; Rats; Rats, Inbred Strains; Sclerosing Solutions

Topics: Adult; Aged; Aorta, Thoracic; Aortic Aneurysm; Aortic Diseases; Aortic Rupture; Aortitis; Esophageal and Gastric Varices; Female; Humans; Male; Middle Aged; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

With the combined peri- and intravascular sclerosing technique esophageal varices can be completely eliminated in an average of three treatment sessions. In order to check the success of the procedure, endoscopic and histological findings at the various stages of treatment after sclerosing with 1% Polidocanol were compared. Clinical and autopsy findings are in agreement. After sclerosing, necroses of the mucosa and intramural inflammations occur regularly in the first week. The varices are thrombosed. Later, the inner wall of the esophagus is cicatricially changed. Histologically the fibroses extend transmurally and in some parts even reach the musculature.

Topics: Adolescent; Adult; Aged; Child; Esophageal and Gastric Varices; Esophagoscopy; Esophagus; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

The significance of serious complications after endoscopic sclerotherapy is growing alone with the increasing popularity of this method. In a consecutive prospective series of 91 patients with massive haemorrhage from oesophageal varices, treated with fiberendoscopic injection sclerotherapy, four cases of oesophageal necrosis and rupture were encountered.

Topics: Adult; Endoscopy; Esophageal and Gastric Varices; Esophageal Perforation; Esophagus; Fiber Optic Technology; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions