polidocanol and Thrombosis

To describe and report incidence and frequency of side-effects and complications of sclerotherapy with foamed sclerosing agents. To explain, when possible, their pathophysiology and to indicate possible manoeuvres and techniques to limit them.. Review of current literature and personal research.. Complications of foam sclerotherapy include complications of sclerotherapy in general and specific complications of foamed sclerosing agents. Side-effects related to the sclerosing compounds are also taken into account.. Complications and side-effects of careful foam sclerotherapy remain uncommon. However, more research is needed to understand them better and to further reduce their incidence. Their description to patients in the course of the informed consent is a prerequisite to any sclerosing treatment.

Topics: Cough; Detergents; Dosage Forms; Embolism, Air; Humans; Intracranial Embolism; Ischemic Attack, Transient; Microbubbles; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate; Thrombosis; Ultrasonography, Interventional; Varicose Veins; Vision Disorders

Venous insufficiency in the small saphenous vein (SSV) is significantly less common than venous insufficiency in the great saphenous vein; the impact of popliteal vein reflux on SSV closure procedural outcomes has yet to be studied.. A retrospective analysis was performed on 150 SSV closure procedures from 2015 to 2019. Preoperative demographic analysis was performed, after which univariate analyses were performed for postoperative occlusion rates and combined rates of endothermal heat-induced thrombus (EHIT) and endovenous foam-induced thrombus (EFIT).. The cohort had a mean age of 58 years, and 116 (77%) were female. Fifty-four patients had C2 disease, 76 had C3 disease, 15 had C4 disease, 1 had C5 disease, and 4 had C6 disease. Twenty-three patients (15.3%) were noted to have popliteal vein reflux on their initial venous insufficiency ultrasound study, compared with 127 (84.6%) who did not. Treatment modalities included 84 radiofrequency ablations (56.0%), 37 polidocanol endovenous microfoam (24.6%), and 29 laser ablations (19.3%). When comparing patients with popliteal vein reflux with those without, there was no significant difference in the occlusion rates at their immediate postoperative visit (99.2% vs 95.6%) or at their 6-month postoperative visit (92.1% vs 91.3%). EHIT/EFIT was noted in 4 of the 23 patients with popliteal vein reflux compared with 4 of the 127 patients without popliteal vein reflux (17.3% vs 3.1%; P = .01). All eight instances of EHIT/EFIT were classified as either arteriovenous fistula class I or II EHIT or EFIT, and all were successfully treated without progression to deep vein thrombosis.. The presence of popliteal vein reflux has no impact on postoperative occlusion rates at 6 months; however, it is associated with a significantly increased rate in EHIT and EFIT. Patients should be counseled on this increased risk should they undergo SSV treatment with known popliteal vein reflux.

Topics: Female; Humans; Laser Therapy; Male; Middle Aged; Polidocanol; Popliteal Vein; Retrospective Studies; Saphenous Vein; Thrombosis; Treatment Outcome; Varicose Veins; Venous Insufficiency

To investigate the in vitro effects of detergent sclerosants on antithrombotic pathways.. Proteins C, S and antithrombin (AT) were assayed in normal plasma treated with increasing concentrations of sodium tetradecyl sulphate (STS) and polidocanol (POL). Activated protein C (APC) was investigated by mixing normal plasmas with sclerosants and testing with the activated partial thromboplastin time (APTT) and dilute Russell's viper venom time in the presence and absence of APC. The effect on factor Xa (FXa), heparin and enoxaparin was investigated using chromogenic anti-FXa and APTT methods.. High concentration (>0.6%) STS significantly destroyed proteins C, S and AT whereas POL only caused a mild reduction in PC and AT and a moderate (60%) reduction in PS levels. STS potentiated the anticoagulant effect of APC while POL increased APC resistance. STS mimicked AT and demonstrated significant anti-Xa and anti-IIa activity. STS demonstrated a similar anticoagulant profile to heparin but was 1000x weaker. It also significantly potentiated the anticoagulant effect of heparin while POL had less effect.. STS and POL demonstrated quite distinct and sometimes opposite effects on the antithrombotic mechanisms assayed. These effects were concentration-dependent and in general, STS had the greatest effect on antithrombotic proteins.

Topics: Anticoagulants; Antithrombins; Blood Coagulation; Detergents; Dose-Response Relationship, Drug; Enoxaparin; Factor Xa; Heparin; Humans; Partial Thromboplastin Time; Polidocanol; Polyethylene Glycols; Protein C; Protein S; Prothrombin; Prothrombin Time; Sclerosing Solutions; Sodium Tetradecyl Sulfate; Thrombosis

Xiao zhi ling (XZL), which consists of Chinese nutgalls and aluminium potassium sulphate, is used as a local injection for the treatment of internal haemorrhoids in China. It is also used for endoscopic sclerotherapy of oesophageal varices. To date, however, it has not been compared with other sclerosants with regard to its safety and efficacy.. In the present study, the effect on the endothelium and the haemolytic and thrombosing effects of XZL were compared with those of 5% ethanolamine oleate and 1% polidocanol, using an endothelial cell line and red blood cells taken from rats and the dorsal marginal ear vein of rabbits. In addition, XZL was injected into the area surrounding varices in rats and its efficacy was studied endoscopically and histologically.. Xiao zhi ling reduced the size of varices in rats after causing severe damage in the injected region. Compared with the other two sclerosants, however, XZL had little effect on the endothelium and was the least haemolytic compound. Furthermore, XZL did not cause thrombosis in the injected vein of a rabbit.. These results suggest that XZL is another type of sclerosant with astringent rather than detergent properties. This compound should be used to treat oesophageal varices by paravariceal injection in smaller doses than 5% ethanolamine oleate and 1% polidocanol.

Topics: Alum Compounds; Animals; Astringents; Cattle; Cell Line; China; Dose-Response Relationship, Drug; Drugs, Chinese Herbal; Endothelium, Vascular; Erythrocytes; Esophageal and Gastric Varices; Hemolysis; Male; Oleic Acids; Polidocanol; Polyethylene Glycols; Rabbits; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy; Thrombosis

Endoscopic injection sclerotherapy is useful in stopping bleeding from esophageal varices. We compared the in vivo effects of sclerosants on thrombogenesis, hemostasis, and endothelial injury. We injected aethoxysclerol (AS) of ethanolamine oleate (EO) into the small veins of the rat intestine. The maximum thrombogenic index with AS was 30.7 and with EO was 9.2. The venous flow stopped sooner with EO than with AS. The thrombi caused by EO were mixed with red blood cells. Heparin pretreatment decreased the thrombogenic index with AS by 96.7%, but not that with EO. The area of the fluorescein-albumin conjugate that permeated from veins with AS was larger than that with EO. The fluorescent intensity with AS was lower than that with EO. We thus conclude that: (1) the size of thrombi is not necessarily proportional to the hemostatic efficacy; (2) change in a patient's coagulation may affect the potential of sclerosants; (3) the excellent hemostatic efficacy of EO is based on localized injury to the endothelium and the involvement of red blood cells aggregation; and (4) in vivo microscopy is useful in determining the rational selection of sclerosants.

Topics: Animals; Capillary Permeability; Endoscopy, Gastrointestinal; Endothelium, Vascular; Fluorescein-5-isothiocyanate; Hemostasis; Hemostatics; Intestinal Mucosa; Male; Oleic Acids; Polidocanol; Polyethylene Glycols; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy; Serum Albumin, Bovine; Thrombosis; Veins

Variceal hemorrhage in a patient with non cirrhotic portal hypertension occurring in mid pregnancy was treated by endoscopic intravasal injection sclerotherapy using polidocanol. It was effective, well tolerated and safe for both mother and child. This is the first report that this treatment is feasible and without risk in pregnancy.

Topics: Adult; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Portal Vein; Pregnancy; Pregnancy Complications, Cardiovascular; Sclerosing Solutions; Thrombosis

Endoscopic papillotomy as therapeutic procedure of first choice for common bile duct stones is related with a relatively low complications rate and exhibits a very low method-related mortality. Major complications are cholangitis, pancreatitis, retroduodenal perforation and hemorrhage. In rare cases minor bleedings after papillotomy may lead to coagulation with consecutive obstruction of the papilla. Jaundice without major clinical symptoms will occur. Diagnosis is established by repeated retrograde cholangiography; conservative management is satisfactory and efficient.

Topics: Aged; Aged, 80 and over; Ampulla of Vater; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis, Extrahepatic; Female; Gallstones; Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Postoperative Complications; Thrombosis