polidocanol and Peripheral-Vascular-Diseases

Peripheral vascular lesions may occur as a result of various clinical problems, cosmetic or dysfunctional causes, or bleeding. In severe cases, coagulopathy and congestive heart failure may occur. Although the efficacy of transarterial embolization (TAE) for arterial vascular lesions is well known, TAE has no effect on low-flow vascular lesions (venous malformations, venous angiomas, and venous components of arteriovenous malformation). Therefore, in such cases, a percutaneous approach is the best method, and we consider sclerotherapy to be the most useful conservative treatment. The primary objective of this study was to confirm the efficacy of percutaneous sclerosing treatment for peripheral low-flow vascular lesions. Lesions were classified on the basis of state of blood flow and morphologic features, and infiltration was classified on the basis of angiographic features and magnetic resonance imaging (MRI) findings. In sclerosing treatment, we used 5% solutions of polidocanol, absolute ethanol, and N-butyl-2-cyanoacrylate (NBCA) as sclerosing agents. Each type of lesion, static or slow-flow, cystic, or localized, showed remarkable improvement after sclerosing treatment with only polidocanol. However, for moderate-to-fast-flow lesions, another sclerosing agent (absolute ethanol/NBCA) was needed. With diffuse infiltrative lesions, surgical repair might be needed, but we recognize the usefulness of sclerosing treatment for functional or cosmetic improvement in these cases.

Topics: Adolescent; Adult; Child; Extremities; Female; Head; Humans; Male; Neck; Peripheral Vascular Diseases; Polidocanol; Polyethylene Glycols; Regional Blood Flow; Retrospective Studies; Sclerosing Solutions; Sclerotherapy

To compare endoscopic variceal ligation (EVL) with a combination of EVL and endoscopic scelerotherapy (EST) in the secondary prophylaxis of esophageal variceal bleeding.. Fifty patients with esophageal varices due to cirrhosis of the liver (38), noncirrhotic portal fibrosis (7), or extrahepatic portal venous obstruction (5) were included in the study. These 50 patients were randomized to receive either EVL alone or a combination of EVL and EST for variceal eradication. Twenty-one patients received EVL alone (group A), and 23 patients received EVL and EST (group B). In group B, EVLs were performed until the varices were reduced to grade II size, and, subsequently, these patients underwent low-dose sclerotherapy with 1% polidocanol until variceal eradication was achieved.. Combined EVL and EST treatment eradicated the varices in a significantly greater number of patients then EVL alone (87% vs. 24%; p < 0.05). However, significantly more endoscopic sessions were required with combined treatment than with EVL alone (5.87 +/- 2.32 vs. 4.28 +/- 1.82; p < 0.05). Rebleeding episodes before variceal eradication were similar in the two groups (19% vs. 22%). The complications were similar in both the EVL and the EVL-plus-EST group, ie., deep ulcers (16% vs. 20%), transient dysphagia (20% vs. 32%), and stricture (4% vs. 8%).. Thus, combined EVL and EST treatment eradicates varices in a significantly larger number of patients than EVL alone, with no extra complications.

Topics: Adult; Combined Modality Therapy; Deglutition Disorders; Esophageal and Gastric Varices; Esophageal Stenosis; Esophagoscopy; Female; Fibrosis; Gastrointestinal Hemorrhage; Humans; Ligation; Liver Cirrhosis; Male; Peripheral Vascular Diseases; Polidocanol; Polyethylene Glycols; Portal Vein; Prospective Studies; Recurrence; Remission Induction; Sclerosing Solutions; Sclerotherapy; Ulcer