polidocanol and Pulmonary-Embolism

To assess the presence of pulmonary embolism and inflammation after polidocanol foam injection into the peripheral veins of rabbits.. The animals were treated with polidocanol foam (1 or 3 mg/kg) or vehicle. Early (15 minutes) and late (30 days) animals were evaluated by perfusional lung scintigraphy and histopathological examination.. In the control group no alterations were found. After polidocanol foam injection it was observed that an important reduction of pulmonary perfusion in the early periods, was mainly in the left lung (P < 0.001), with consequent embolism in the histological evaluation. In late periods it was observed that the presence of thrombus was with fibrin in small veins, compatible with chronic thrombus and the presence of chronic pulmonary inflammation.. The injection of polidocanol foam in experimental animals can induce venous embolism and chronic inflammatory infiltration.

Topics: Acute Disease; Animals; Chronic Disease; Female; Lung; Male; Polidocanol; Polyethylene Glycols; Pulmonary Embolism; Rabbits; Sclerosing Solutions; Time Factors

Topics: Angiography; Diagnosis, Differential; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Hypoxia; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Pulmonary Embolism; Sclerosing Solutions; Sclerotherapy; Tomography, Spiral Computed

Sclerotherapy with absolute ethanol and/or polidocanol is a well-established therapeutic modality for the treatment of peripheral vascular malformations, although systemic complications such as hemoglobinuria and pulmonary embolism could occur. We report two cases of pulmonary embolism associated with sclerotherapy for peripheral vascular malformations. Two patients, a 17-year-old man and a 17-year-old woman, undergoing absolute ethanol sclerotherapy for vascular malformations of the leg developed pulmonary embolism after injection of ethanol. Pulmonary embolism, suspected by the clinical symptoms such as hypoxia and hypocapnia, was confirmed by the pulmonary scintigraphy showing minimal pulmonary defects. Hemoglobinuria was also observed with injection of ethanol. Patients recovered rapidly with heparin and urokinase therapy. The review of perioperative complications with sclerotherapy for peripheral vascular malformations in our institution for past four years revealed that complications were observed in 18 out of 88 patients (20.5%), and in 32 out of 183 cases (17.5%). Major complications were hemoglobinuria, pulmonary embolism, shivering and delayed emergence from general anesthesia. We conclude that sclerotherapy for vascular malformations under general anesthesia is a risky procedure and this must be carefully managed with keen monitoring of Spo2 and Etco2.

Topics: Adolescent; Anesthesia, General; Ethanol; Female; Hemoglobinuria; Heparin; Humans; Leg; Male; Polidocanol; Polyethylene Glycols; Pulmonary Embolism; Sclerotherapy; Treatment Outcome; Urokinase-Type Plasminogen Activator; Veins

A 79-year-old man was admitted with a history of recent haematemesis and tarry stools. 4 years before he had undergone a subtotal thyroidectomy for hyperthyroidism.. He was anaemic (haemoglobin 7.2 g/dl, haematocrit 23%). At the transition between the upper and middle third of the oesophagus gastroscopy revealed a bleeding oesophageal varix.. The bleeding varix was sclerosed with polidocanol. 3 erythrocyte concentrates were administered. Massive bleeding 2 days later was controlled with intravaricose injection of cyanoacrylate (Histoacryl). The patient died 6 weeks later from progressive cardiovascular failure. Autopsy revealed the cause of death as right heart failure with extensive foreign-body pulmonary emboli identified as thrombotic material containing polymerized cyanoacrylate found in the previously injected oesophageal varix. Also discovered was a retrosternal goitre which had compressed the brachiocephalic vein. Cause of the "washing-out" of the cyanoacrylate embolus from the varix into the systemic circulation was an oesophago-varicose collateral circulation in a cranio-caudal direction; this had been formed by the pressure of the retrosternal goitre on the brachiocephalic vein.. Cyanoacrylate injection into a varix above the lower third of the oesophagus should only be done under strict indication. A similar risk as that described in this case potentially exists in the treatment of acute bleeding from a portosystemic varicose circulation.

Topics: Aged; Autopsy; Embolization, Therapeutic; Enbucrilate; Esophageal and Gastric Varices; Foreign Bodies; Gastrointestinal Hemorrhage; Humans; Male; Polidocanol; Polyethylene Glycols; Pulmonary Embolism; Sclerosing Solutions

Topics: Adult; Female; Humans; Polidocanol; Polyethylene Glycols; Pulmonary Embolism; Sclerosing Solutions