polidocanol and Vascular-Malformations

Sclerotherapy for venous malformation has been widely used; however, no guidelines are available to assess the effectiveness of different sclerotherapy agents. We conducted a systematic review and network meta-analysis to investigate the effectiveness of sclerotherapy agents for venous malformations.. Three electronic databases were searched from their inception (1950) to April 29, 2021. Studies comparing the effectiveness of different sclerotherapy agents were included. The risk of bias within and across studies was assessed. Pairwise meta-analyses were conducted, followed by a network meta-analysis. We also assessed inconsistency and publishing bias using various approaches.. Seven studies with 547 patients in six arms were included in the present study. We defined the response and complete response as two separate outcomes. Significant differences were observed in four comparisons with respect to the response (ethanol vs bleomycin, ethanol vs polidocanol, ethanol vs sodium tetradecyl sulfate, polidocanol vs sodium tetradecyl sulfate). No statistically significant differences were found in the other comparisons. The evidence network revealed that for the response outcome, ethanol ranked first, followed by pingyangmycin, polidocanol, sodium morrhuate, bleomycin, and, finally, sodium tetradecyl sulfate. For the complete response outcome, pingyangmycin had the best results, followed by sodium morrhuate, polidocanol, ethanol, bleomycin, and, finally, sodium tetradecyl sulfate. Major complications, such as facial nerve palsy, serious local swelling, and necrosis, had occurred mostly in the ethanol group and rarely in the other groups. Because of the limited data, no further analysis of major complications was conducted. Our confidence in the comparisons and rankings was low. We found no verified inconsistency or publishing bias in the present study using the existing approaches.. Ethanol showed a significantly better response statistically compared with the other agents. However, ethanol had also resulted in the highest incidence of complications. Pingyangmycin showed the second-best response, best complete response, and a low rate of complications, respectively. Overall, pingyangmycin achieved excellent performance and balance in terms of the different outcomes. However, they could not be adequately recommended from the available data. More superior trials, especially randomized controlled trials, are needed in the future.

Topics: Bleomycin; Ethanol; Humans; Network Meta-Analysis; Polidocanol; Sclerosing Solutions; Sclerotherapy; Sodium Morrhuate; Sodium Tetradecyl Sulfate; Treatment Outcome; Vascular Malformations

Venous malformations (VM) are common vascular malformations. Percutaneous injection of sclerosants into the lesion has become mainstream therapy. The most commonly used sclerosants are ethanol, polidocanol, bleomycin, and the like. But few articles have reported that sclerosants are more effective and safer.. We performed a search on Cochrane, Embase, PubMed, China National Knowledge Infrastructure, CBM, and Wan Fang databases of Controlled Trials (from January 1, 2010, launch up to April 10, 2019) reporting outcome of intralesional ethanol, polidocanol, and bleomycin injections in patients with VM (n ≥ 20). A meta-analysis was conducted using Rev-man 5.3 software.. A total of 9 articles, 632 participants and 676 lesions were included. Quality of evidence was generally low. Meta-analysis showed that absolute ethanol treatment was better than polidocanol in treating VM (p = .001), and absolute ethanol elicited a better response than bleomycin (p = .01). Ethanol therapeutic effect was not statistically significant compared with ethanol alone (p = .07), but the combination effect was better than polidocanol (p = .04). Ethanol treatment showed significantly more adverse reactions than polidocanol and combination therapy.. Absolute ethanol combined with polidocanol is more effective in treating VM and has fewer adverse reactions.

Topics: Bleomycin; Drug Therapy, Combination; Ethanol; Humans; Injections, Intravenous; Polidocanol; Randomized Controlled Trials as Topic; Sclerosing Solutions; Treatment Outcome; Vascular Malformations; Veins

Topics: Anemia; Child; Duodenum; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Humans; Injections, Intralesional; Nevus, Blue; Polidocanol; Sclerosing Solutions; Sclerotherapy; Skin Neoplasms; Treatment Outcome; Vascular Malformations

A meta-analysis was conducted to investigate the efficacy and safety of polidocanol versus other conventional therapies in treating hemangiomas (HMs) and vascular malformations (VMs). Literature search was conducted in the Cochrane, Embase, PubMed, Web of Science, CNKI, CBM, VIP, and WanFang databases until March 5, 2017. A meta-analysis was conducted using Revman 5.3 software. A total of 19 randomized controlled trials (RCTs) involving 1,514 participants met the inclusion criteria. Regarding the effectiveness, statistically significant differences were observed between polidocanol and all the independent treatments (p = .006), but not between polidocanol and pingyangmycin (p = .16). Combination therapy of polidocanol with any other conventional treatments (p = .0001), pingyangmycin (p = .005) or hemoclip (p = .008) elicited a better response compared to treatment with these treatments independently. A meta-analysis on the risk of adverse events (AEs) showed a lower risk for polidocanol versus other treatments, for example, all the conventional treatments used independently (p < .00001) and pingyangmycin (p < .00001). Combination therapy of polidocanol with pingyangmycin also yielded a significantly lower risk of AEs (p < .00001). Polidocanol is at least as effective as other conventional therapies on HMs and VMs (especially venous malformations). The former is much safer. Combining its use with other treatments may produce excellent results. Our study provides strong evidence supporting the use of polidocanol for HMs and VMs.

Topics: Adolescent; Adult; Aged; Antibiotics, Antineoplastic; Bleomycin; Chi-Square Distribution; Child; Child, Preschool; Female; Hemangioma; Humans; Infant; Infant, Newborn; Male; Middle Aged; Odds Ratio; Polidocanol; Polyethylene Glycols; Randomized Controlled Trials as Topic; Risk Factors; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations; Young Adult

Treatment by sclerotherapy has been suggested as a first-line treatment of low-flow vascular malformations. This study reports our experience in treating low-flow vascular malformations by ultrasound-guided sclerosis with polidocanol foam at the Vascular Medicine Department in Grenoble, France.. Retrospective single-centre consecutive series.. Between January 2006 and December 2009, we analysed the complete records of patients with symptomatic low-flow vascular malformations of venous, lymphatic or complex type (Klippel-Trenaunay syndrome, KTS) treated by ultrasound-guided sclerosis. The therapeutic indication was always validated by the Consultative Committee for vascular malformations of the University Hospital of Grenoble. All vascular malformations were classified according to the Hamburg Classification. The sclerosing agent was polidocanol used as foam.. A total of 24 patients between 7 and 78 years were treated (19 venous malformations, three KTSs and two venous-lymphatic malformations). The concentrations of polidocanol used ranged from 0.25% to 3%. The average number of sessions was 2.3 (1-16). After a median follow-up at 5 months after the last session, 23 out of 24 patients reported a decrease in pain; in nine cases (37.5%), over 50% reduction in size was observed, and in 14 cases (58.3%), a reduction of less than 50% of the original size was obtained. Two minor side effects were reported.. Treatment by ultrasound-guided sclerosis using polidocanol foam seems to be well tolerated and can improve the symptoms of low-flow malformations without the risks of more aggressive sclerosing agents, such as ethanol.

Topics: Adolescent; Adult; Aged; Child; Female; France; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Regional Blood Flow; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome; Ultrasonography, Interventional; Vascular Malformations; Young Adult

This single-center, single-arm, prospective open-label trial is being conducted to evaluate the short-term efficacy and safety of percutaneous sclerotherapy with polidocanol foam for painful venous malformations. This study will include patients who were clinically diagnosed with venous malformation by using ultrasound and/or magnetic resonance imaging, and whose pain persisted even after treatment with medications. Written informed consent for sclerotherapy will be obtained from all patients. The institutional review board approved this prospective study protocol. The primary endpoint is pain relief at three months after sclerotherapy. Local pain related to venous malformation will be evaluated using a numeric rating scale. Patient recruitment commenced in December of 2020. Enrolment of 13 patients is planned over a 3-year recruitment period. Herein, we describe the details of the clinical trial protocol.

Topics: Humans; Pain; Polidocanol; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

To compare the clinical efficacy of pingyangmycin and lauromacrogol combined with pingyangmycin in the treatment of venous malformations (VMs).. One hundred and twenty patients with VM were randomly divided into lauromacrogol combined with pingyangmycin injection group (experimental group) and pingyangmycin injection group (control group). The appropriate interval between different injection sessions was 2 weeks. After different sessions, the changes of lesions (including size, color, texture) as well as the results of posture test and adverse effects were analyzed by using SPSS11.5 software package.. According to the international evaluation criteria for VM, the efficacy of the experimental group was significantly better than the control group after 2~5 sessions (P<0.05). However, after 1 and 6 sessions, there was no significant difference in the efficacy between the experimental group and the control group (P>0.05). In addition, the average sessions required in the experimental group were significantly less than those in the control group (P<0.05).. Compared to the single use of pingyangmycin, lauromacrogol combined with pingyangmycin is more effective for the treatment of VM, with fewer sessions required and no adverse effects.

Topics: Bleomycin; Color; Female; Humans; Injections, Intralesional; Male; Polidocanol; Polyethylene Glycols; Posture; Sclerotherapy; Treatment Outcome; Vascular Malformations; Veins

To compare the clinical outcome between ultrasound-guided foam sclerotherapy (UGFS) and ultrasound-guided liquid form sclerotherapy (UGLS) in patients with venous malformations (VM).. Eighty-nine patients with symptomatic VM were treated with ultrasound-guided sclerotherapy. There were 22 males and 67 females with mean age of 14.5 years. The sclerosing agents used were 1% polidocanol (POL) or 10% ethanolamine oleate (EO). POL was injected predominantly into smaller, superficial lesions, whereas EO was used for large, deeper lesions. Foam sclerosing solution was provided using Tessari's method. Patients were randomized to receive either UGFS or UGLS. Post-sclerotherapy surveillance was done at 6 months after last session using duplex ultrasound. Findings obtained by duplex scanning were divided into four groups: (1) disappeared group: the venous space was occluded and was totally shrunk; (2) partially recanalized group: the venous space was partially recanalized and was partially shrunk; (3) totally recanalized group: the venous space was totally recanalized and returned at the same size; and (4) worsened group: the venous space was totally recanalized and became worse.. Forty-nine patients were treated with UGFS and the remaining 40 were treated with UGLS. There were no significant differences in age and men:women ratio. There was no significant difference in the anatomic distribution of VMs between the two groups. The amount of POL was significantly smaller in patients who were treated with UGFS (P = .022). Similarly, there was a significant reduction in the use of EO in patients treated with UGFS (P = .005). The proportion of VM with total disappearance and partial recanalization was significantly higher in patients treated with UGFS (P = .002). No major complications related to sclerotherapy were encountered in both groups.. These findings suggest that UGFS could have greater promise compared with UGLS in the treatment of VMs.

Topics: Adolescent; Adult; Female; Humans; Male; Oleic Acids; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Ultrasonography, Interventional; Vascular Malformations; Veins

The objective of this research was to retrospectively investigate the difference of safety and efficacy between polidocanol foam and bleomycin polidocanol foam (BPF) in the treatment of venous malformations (VMs), and provide clinical evidence for the application of BPF for VMs.. Patients with VMs treated with polidocanol foam and BPF were included between July 2018 and July 2020. The VM tissue involvements and symptoms were collected. The treatment outcomes were evaluated by the clinical improvement of symptoms and the degree of devascularization on ultrasound examination or magnetic resonance imaging. Patients were followed up for 1, 3, and 6 months after the sclerotherapy. Immediate and delayed complications were closely followed and recorded.. A total of 51 patients were included, including 34 females and 17 males with a mean age of 26.8 years (range, 5-65 years). The most commonly involved sites were lower extremities (31/60 [51.7%]) and the most common symptom was pain (33/51 [64.7%]). Fifty-four sclerotherapies were performed with a mean of 1.06 ± 0.24 sessions (range, 1-2 sessions) per patient. The reduction percentage of lesion volume in the BPF group was significantly higher than the polidocanol foam group (79.4 ± 1.6% vs 55.7 ± 6.1%; P < .001). Patient satisfaction scores in the BPF group were significantly higher than the polidocanol foam group (7.2 ± 1.1 vs 5.7 ± 0.8; P < .001). No major complication was observed in either group. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) grade 1 complications occurred in 5 of 21 patients in the BPF group and 7 of 30 patients in the polidocanol foam group, CIRSE grade 2 complications occurred in 5 of 21 patients in the BPF group and 4 of 30 patients in the polidocanol foam group; there were no significant differences between the two groups.. BPF is a safe and effective sclerosant for VMs, showing better efficacy and similar safety as commonly used mild sclerosants. It could be a promising agent to treat VMs or other slow-flow vascular malformations.

Topics: Adult; Bleomycin; Female; Humans; Male; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

This study evaluated the effectiveness and safety of percutaneous sclerotherapy for maxillofacial venous malformations.. Patients who had venous malformations involving the masticatory muscles and who underwent sclerotherapy were enrolled in this retrospective study.. Twenty-four patients (13 female, 11 male; mean age 21 years) were analyzed. Major clinical symptoms were swelling (100%) and intralesional pain (54%). Intramuscular lesions involved the masseter muscle only in 38% of cases, both the masseter and temporalis muscles in 33%, all masticatory muscles in 21%, and the temporalis muscle only in 8%. Extramuscular involvement was observed in 58% of patients. Absolute ethanol and polidocanol were used as sclerosants. The mean number of sclerotherapy sessions per patient was 6.6 (range, 1-32). The mean follow-up duration after the first sclerotherapy session was 64.8 months (range, 6-178). The complications included paralysis of the facial nerve (25%), intraoral ulceration (8%), and hemoglobinuria (8%). The effectiveness of treatment was rated as excellent in 33% of cases, good in 46%, and fair in 21%. Better results were obtained in patients without extramuscular involvement.. Percutaneous sclerotherapy can be effective and safe for maxillofacial intramuscular venous malformations, especially for localized lesions of the masseter muscle.

Topics: Adult; Ethanol; Female; Humans; Male; Masticatory Muscles; Polidocanol; Retrospective Studies; Sclerotherapy; Treatment Outcome; Vascular Malformations; Young Adult

This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction.. Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire.. This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45 years (range 3-72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction (. Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Patient Satisfaction; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations; Young Adult

To evaluate the efficacy and safety of lauromacrogol foam sclerotherapy in the treatment of children with lip venous malformation.. Fifty-two children (27 males and 25 females) aged from 6 months to 17 years with lip VM who underwent lauromacrogol foam injection with ultrasonic guidance from July 2018 to December 2020 in our hospital were retrospectively recruited for this study. All the children were examined by MRI, ultrasound, blood routine and coagulation before operation. We were guided by ultrasound to locate the blood flow area (nests), injecting lauromacrogol foam to fill the venous malformation. The follow-up time was 14.31 ± 5.96 (6-24) months. Follow-up items include clinical manifestations, imaging data, efficacy and complications.. This group of children was treated 3-5 times, an average of 4 times/case. The total effective rate was 90.38%. Pain in 4 cases, fever in 4 cases, infection in 2 cases, ulcer in 1 case. There were no serious complications such as cardiopulmonary accident.. Ultrasound guiding foam sclerotherapy with lauromacrogol is effective and safe for children with lip venous malformation.

Topics: Child; Female; Humans; Lip; Male; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Ultrasonics; Vascular Malformations

This study aimed to evaluate the value of fat-suppressed T2-weighted imaging (FS-T2WI) for predicting short-term pain relief after polidocanol sclerotherapy for painful venous malformations (VMs) in the extremities.. This retrospective study included patients with painful VMs in the extremities between October 2014 and September 2021, had their first sclerotherapy without history of surgical therapy, and underwent magnetic resonance imaging before sclerotherapy. Pain relief was assessed 2 months after 3% polidocanol sclerotherapy and was categorized as follows: progression, no change, partial relief, or free of pain. The associations between pain relief and imaging features on FS-T2WI were analyzed.. The study included 51 patients. The no change, partial relief, and free of pain groups included 6 (11.8%), 25 (49.0%), and 20 (39.2%) patients, respectively. No patient experienced progressive pain. The lesion diameter was ≤ 50 mm in 13 (65.0%) patients in the free of pain group, whereas it was > 50 mm in all patients in the no change group (p = 0.019). The lesions showed well-defined margin in 15 (75.0%) patients in the free of pain group, whereas they showed ill-defined margin in 5 (83.3%) patients in the no change group (p = 0.034). The most common morphological type was cavitary in the free of pain group (14 [70.0%] patients), whereas there was no patient with cavitary type lesion in the no change group (p = 0.003). Drainage vein was demonstrated in 6 (100%), 22 (88.0%), and 11 (55.0%) patients in the no change, partial relief, and free of pain group, respectively (p = 0.011).. A lesion size of 50 mm or less, a well-defined margin, a cavitary type, and no drainage vein on FS-T2WI were significant features for predicting short-term pain relief after polidocanol sclerotherapy for painful VMs in the extremities.

Topics: Extremities; Humans; Magnetic Resonance Imaging; Pain; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

To evaluate the efficacy of sclerotherapy for congenital vascular malformation (CVM) using a combination of polidocanol foam and bleomycin liquid.. A retrospective review of a prospectively collected data on patients who had sclerotherapy for CVM from May 2015 to July 2022 was performed.. A total of 210 patients with a mean age of 24.8 ± 2.0 years were included. Venous malformation (VM) was the most common type of CVM, accounting for 81.9% (172/210) of all patients. At 6 months follow-up, the overall clinical effective rate was 93.3% (196/210), and 50% (105/210) of patients were clinically cured. The clinical effective rates in VM, lymphatic, and arteriovenous malformation group were 94.2%, 100%, and 100%.. Sclerotherapy using a combination of polidocanol foam and bleomycin liquid is an effective and safe treatment for venous and lymphatic malformations. It is a promising treatment option with satisfactory clinical outcome in arteriovenous malformations.

Topics: Adult; Arteriovenous Malformations; Bleomycin; Humans; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations; Young Adult

Sclerotherapy has achieved great success in treating most venous malformation (VM) lesions.. To compare the effects of foam sclerotherapy on infantile hemangioma and pyogenic granuloma (PG). In addition, we analyzed the data and outcomes of foam sclerotherapy for the VM.. Thirty-nine patients with hemangiomas and 83 patients with VMs were treated, and clinical outcomes, resolution, and complication rates were compared. Sclerotherapy data from the VM group were also analyzed.. The average age of the patients and the distribution and tissue involvement of lesions among the 3 groups were significantly different ( p < .001). The average amount of sclerosing foam administered per session in VMs was significantly higher than that in the other 2 groups ( p < .0001) (whereas that in the PG group was lower than that in the infantile hemangioma group [ p < .0001]). However, the overall therapeutic efficacy and side effects in the 3 groups were not significantly different. For VMs, the frequency of ultrasound guided foam sclerotherapy and use of 3% polidocanol increased from superficial to deep lesions, whereas the use of 1% POL decreased ( p < .0001).. Infantile hemangioma and PG treatments presented good results and minor adverse reactions comparable with those of VMs.

Topics: Hemangioma; Hemangioma, Capillary; Humans; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

Vascular malformations are rare diseases and treatment remains controversial. Sclerotherapy is accepted as a minimally invasive treatment with good results; however, some patients do not report good response to sclerotherapy, and it is not clear which variables influence treatment outcome, preventing optimal patient selection. We hypothesized that large diameter lesions have reduced efficacy and satisfaction with sclerotherapy. Therefore, we prospectively evaluated the clinical response of low-flow vascular malformations treated with 1% polidocanol foam sclerotherapy and determined the correlation of symptom improvement with clinical variables.. Prospective cohort study of patients with symptomatic low flow vascular malformations treated at the Hospital das Clínicas between December 2016 and November 2018. Lesions were classified according to location, extension, diameter, type of vessels, margins, and symptoms. Sclerotherapy was performed by direct injection of 1% polidocanol foam, with a maximum volume of 10 ml per session. Symptom improvement was evaluated using the visual analog scale and patient-reported quality of life was assessed by the Short-form 6 dimensions (SF-6D) questionnaire. Follow-up was performed every 3 months after treatment.. Forty lesions were treated in 38 patients, with 19 women and 19 men; median age was 20.5 years (range 4 months to 63 years). Most lesions (80%) were venous, and most commonly in the lower limbs (47.5%); 27.5% were superficial, 35% were deep, and 37.5% affected both compartments. The most common clinical presentations were deformity (95%), pain (78%), and functional limitation (58%); deep compartment lesions were more associated with functional limitation (69% vs. 27%; P = 0.030). Fifty-three per cent of lesions were >10 cm and were associated with increased numbers of psychosocial symptoms (P = 0.038). Two-hundred and forty-two sessions of sclerotherapy were performed, with 6 mean treatments per lesion (range 1-15). The mean follow-up time was 23 months (range 2-23 months). The most common complications were pain and local edema, without any major complications; some patients reported symptom recurrence (15% pain, 10% deformity, and 12% functional limitation). Sclerotherapy was associated with significant improvement of all symptoms (P < 0.001). However, lesions >10 cm were associated with poor improvement in deformity (P = 0.003). Quality of life improved for most patients (60%) and treatment satisfaction was high (82%).. Treatment of low-flow vascular malformations with 1% polidocanol foam is safe and effective; sclerotherapy improves symptoms and quality of life. Large diameter lesions (>10 cm) are associated with increased treatment failure. A small percentage of patients reported recurrent symptoms and require other modalities for successful treatment.

Topics: Female; Humans; Infant; Male; Pain; Polidocanol; Prospective Studies; Quality of Life; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

To assess the effectiveness, safety, and predictors of outcomes and adverse events for percutaneous sclerotherapy using polidocanol for the treatment of venous malformations (VMs).. A retrospective single-center analysis was performed, including patients with VMs who were treated with sclerotherapy using polidocanol between January 2011 and November 2021 at a tertiary center. Demographic characteristics, clinical data, and radiologic features were analyzed, and the influence of patient- and VM-related factors on the subjective clinical outcome and adverse events were investigated using a multivariate logistic regression analysis.. In total, 167 patients who received 325 treatment sessions were included in this study. Overall symptom improvement was observed in 67.5%, stable symptoms were observed in 25.0%, and worsening was reported in 7.5% (clinical follow-up, 1.04 ± 1.67 years). The total adverse event rate was 10.2%, with an overall rate of 4.2% for permanent adverse events within the cohort. In multivariate analysis, the clinical outcome was worse in children (P = .01; 57.1% symptom improvement in children [age, <18 years] and 79.7% in adults), and adverse events were more frequently observed after the treatment of VMs located at the extremities (P < .01; 8.4% for VMs of the extremities and 1.2% for VMs in other locations).. Sclerotherapy using polidocanol can be an effective treatment option for VMs with an acceptable safety profile. However, it can be less effective in children, and adverse events can be more frequently expected for VMs of the extremities.

Topics: Adolescent; Adult; Child; Humans; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

Topics: Humans; Lip; Polidocanol; Radiofrequency Ablation; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

Polidocanol sclerotherapy of head and neck venous malformations (VMs) and lymphatic malformations (LMs) has been reported only in limited series. In this manuscript we evaluated the efficacy and safety of polidocanol sclerotherapy in a series of head and neck venous and lymphatic malformations.. This retrospective observational study analysed data on 20 head and neck VMs and LMs that underwent to percutaneous or endoscopic intra-lesional 3% polidocanol microfoam sclerotherapy at our institution. Clinical response was ranked as excellent, moderate and poor based on volume reduction by MRI and resolution of symptoms.. The median volume decreased from 19.3 mL to 5.8 mL after sclerotherapy (mean volume reduction: 72.98 ± 16.1%). An excellent-moderate response was observed in 94.4% of cases. We observed a mean volume reduction of 79.5 ± 16.1 in macrocystic LMs, of 76.1 ± 13.0% in VMs, of 60.5 ± 10.9% in mixed lymphatic ones and 42.5% in microcystic lymphatic ones.. Polidocanol sclerotherapy appears to be an effective and safe treatment for venous and lymphatic head and neck malformations. We observed the best responses in macrocystic LMs and VMs, whereas mixed lymphatic ones showed a moderate response and microcystic lymphatic ones a poor response.. La scleroterapia con polidocanolo nella gestione delle malformazioni venose e linfatiche del distretto testa-collo.. La scleroterapia con polidocanolo (POL) nelle malformazioni venose (VM) e nelle malformazioni linfatiche (LM) della testa e del collo è stata descritta solo in casisitiche limitate. In questo lavoro abbiamo valutato l’efficacia e la sicurezza del POL in pazienti affetti da VM e LM della testa e del collo.. Sono stati analizzati i dati di 20 pazienti affetti da VM e LM del testa-collo, sottoposti a scleroterapia con POL al 3%, iniettato nella lesione per via percutanea o endoscopica. La risposta è stata classificata come eccellente, moderata o scarsa in base alla riduzione del volume valutata mediante risonanza magnetica e alla risoluzione dei sintomi.. Il volume mediano si è ridotto da 19,3 ml a 5,8 ml dopo il trattamento (riduzione volumetrica media: 72,98 ± 16,1%). Il 94,4% dei casi ha ottenuto una riposta eccellente-moderata. In particolare è stata osservata una riduzione volumetrica media del 79,5 ± 16,1% nelle LM macrocistiche, del 76,1 ± 13,0% nelle VM, del 60,5 ± 10,9% LM miste e del 42,5% nell’unica LM microcistica.. La scleroterapia con POL sembra essere un trattamento efficace e sicuro: i risultati migliori sono stati ottenuti nelle LM macrocistiche e nelle VM, mentre le LM miste hanno mostrato una moderata risposta e le LM microcistiche una scarsa risposta.

Topics: Head; Humans; Lymphatic Abnormalities; Neck; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

To describe the effectiveness and security of DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children.. A total of 9 cases children with penile venous malformations treated by DSA-guided percutaneous sclerotherapy from January 2017 to June 2018 were enrolled in this study. Local angiography was performed under DSA fluoroscopy, and the shape, extent and venous drainage of the tumor nest were judged. Then sclerosing agents (Pingyangmycin and Polidocanol) were selected according to the flow rate of angiography and treated by percutaneous injection under DSA monitoring. Imaging examination (MRI) was performed to evaluate clinical improvement.. A total of 26 interventional sclerotherapy sessions were performed in 9 children, with an average of (2.3±0.5) sessions per case. After a mean follow-up of 7.3 months, 6 cases were cured, and 3 cases were in basic remission. There were 9 cases of temporary edema secondary to the treatment site and 3 cases of mild pain. No serious complications such as ulceration, hemorrhage, infection and dysfunction occurred in any patients.. DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children is safe and effective, does not affect the appearance and function of penis, and is worthy of clinical promotion.. Treatment Study.. Level IV, Case series with no comparison group.

Topics: Child; Humans; Male; Penis; Polidocanol; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

To describe results of image guided sclerotherapy of venous malformations (VM) localized in the masseter muscle.. Retrospective review of prospectively maintained data was done to include consecutive cases treated over 5-year period, with minimum 6 months follow-up. Sclerotherapy was done using ultrasound (US) guided needle puncture(s) of the lesions percutaneously, and 3% polidocanol foam injected under image guidance.. Seventeen cases (10 male, 7 female) with mean age 15.6 years (range 6-28 years) were identified. Clinical presentation was with facial asymmetry, becoming pronounced on jaw clenching, and three cases had mild local pain. On US, the lesions appeared as partially compressible masses with anechoic spaces, showing color filling on releasing probe pressure. Fourteen had phleboliths. Eight patients had undergone magnetic resonance imaging, lesions appearing as oval, homogenous, lobulated, T2 hyperintense masses, with heterogeneous contrast enhancement. Number of sclerotherapy sessions were-single in four cases, two in eight cases and three in five cases, for total of 35 sessions (average 2.05 session per patient). The mean dose of drug injected per session was 1.85 mL and total mean dose per patient was 2.79 mL. Post-procedure vomiting occurred in one patient while all had local swelling and mild pain, lasting between 3 to 7 days. No facial nerve palsy or sloughing/ulceration/skin necrosis was noted. On US follow-up (6-26 months, mean 15.9 months), 12 patients had small echogenic masses without any vascularity, and five had small anechoic areas <25%. All patients had complete resolution of swelling and pain.. For VMs localized to the masseter muscle, image guided sclerotherapy is highly effective and safe, and recommended as first line treatment.

Topics: Adolescent; Adult; Child; Cohort Studies; Female; Humans; Magnetic Resonance Imaging; Male; Masseter Muscle; Phlebography; Polidocanol; Punctures; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Ultrasonography; Ultrasonography, Doppler, Color; Vascular Malformations; Veins; Young Adult

This study investigated the in vitro stability of a novel sclerosant, bleomycin polidocanol foam (BPF), for venous malformation (VM) sclerotherapy.. The study was designed with control groups treated with polidocanol (0.5%, 1%, and 3%) only. The experimental groups included 21 BPFs, which was made by dissolving bleomycin at seven different concentrations (0.1%-1.5%) in polidocanol (0.5%, 1%, and 3%). The Tessari method was used to prepare sclerosant foam with a liquid:gas ratio of 1:4 at room temperature in vitro. The foam stability was measured for each group. The decay process, one component of foam stability, was recorded with a camera. Foam decay process experiments were performed 10 times per group. The stability indices included drainage rate, drainage time, half life, and microscopic measurement of the foams (mean bubble diameter, minimum and maximum bubble diameters, wall thickness, and bubble diameter distribution).. Compared with the control groups, the half lives of BPFs mainly increased significantly with the addition of bleomycin (p < .001). BPF with 3% polidocanol and 0.1% bleomycin recorded the highest half life (246 ± 1.6 sec), and this group also achieved the smallest bubble diameter and wall thickness (69.9 μm and 5.80 μm) among the experimental groups. For the same polidocanol concentration, the bubble diameter and wall thickness increased when bleomycin was added.. Bleomycin concentrations account for different BPF stability. BPF stability mainly increased significantly with the addition of a small amount of bleomycin but this advantage was no longer apparent with increasing bleomycin dose.

Topics: Bleomycin; Drug Combinations; Drug Stability; Humans; Polidocanol; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Veins

The aim of this study was to evaluate the safety and clinical outcomes of percutaneous sclerotherapy of venous disorders of the labia majora in patients with vascular malformations of the lower limbs.. Thirty percutaneous sclerotherapy treatments were performed over a 6-year period among 17 female patients with symptomatic venous malformation (VM) or secondary varicosis of the labia majora. Four patients were treated with sclerotherapy alone, 13 patients had additional procedures to control the VM before sclerotherapy. Polidocanol was used as sclerosant. Indications for sclerotherapy included pain, bleeding, thrombophlebitis, and swelling. Genitourinary symptoms were recorded. The number of treatments and procedure-related complications were registered. Complications were classified according to the Society of Interventional Radiology (SIR) classification system (grade A-E). The 3-month postintervention follow-up included magnetic resonance imaging, clinical examination, and a symptom-related questionnaire. If no reintervention was necessary, consultation was scheduled biannually.. All patients had local swelling and pain; only a fraction of the patients had further symptoms with bleeding or thrombophlebitis (47% each). Eight patients required reintervention. No major complications were observed; minor complications such as postprocedural swelling occurred in 29% (SIR grade A), pain occurred in 17% (SIR grade B), and skin blistering developed in 5% (SIR grade B). Upon follow-up examination after a median of 40 months, 76% showed complete relief of symptoms, and 23% reported partial relief. All patients reported a substantial reduction in pain (75% >5 points in visual analogue scale) and swelling (88% complete cessation).. Percutaneous sclerotherapy is a safe and effective treatment option of VM and secondary varicosis of the labia majora.

Topics: Adult; Child; Female; Humans; Middle Aged; Polidocanol; Regional Blood Flow; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome; Varicose Veins; Vascular Malformations; Veins; Vulva; Young Adult

The objective of this study was to retrospectively review the clinical and radiographic outcomes of patients with venous malformations (VMs) treated with bleomycin-polidocanol foam (BPF) sclerotherapy.. The Institutional Review Board waived ethical approval for this retrospective review in which 55 patients (31 female and 24 male patients; mean age, 18.8 years; range, 2-60 years) were treated with BPF sclerotherapy. The stability (half-life) of BPF compared with polidocanol foam was studied. Standard sclerotherapy techniques were used. A total of 111 sclerotherapy sessions were performed, with a mean of 2.0 treatments per patient (range, 1-6). An average of 10 mL of BPF was used per procedure, with the total amount ranging from 2.5 to 30 mL. Symptoms before and after treatment, follow-up time, complications, and volume reduction on magnetic resonance imaging were recorded.. The median half-lives of the BPF and polidocanol foam were 238.25 ± 3.86 seconds and 194.33 ± 3.5 seconds, respectively. A t-test indicated significant differences between the groups (P < .01). The mean follow-up was 14 months (range, 6-24 months). All 55 patients (100%) reported improvement in symptoms. The total excellent and good response rate was 94.6%. An excellent response was achieved in 32 cases (58.2% [32/55]), a good response in 20 cases (36.4% [20/55]), and a poor response in 3 cases (5.4% [3/55]). Postprocedural magnetic resonance imaging demonstrated volume reduction of treated lesions in 54 of 55 patients (98%), with a mean lesion volume reduction of 84.6%. Postprocedure complications were minor in 13 of 111 procedures (12%) that were performed on 10 of 55 patients (18.2%), and no major complications occurred.. BPF sclerotherapy of VMs is safe and effective. BPF sclerotherapy can be a promising first-line treatment of VMs.

Topics: Adolescent; Adult; Bleomycin; Child; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome; Vascular Malformations; Veins; Young Adult

Congenital vascular malformations are a heterogeneous group of lesions with the potential to cause significant lifelong morbidity in children. Diagnosis and treatment of these lesions may be complex and require a multidisciplinary approach. Sclerotherapy is widely used for the treatment of low-flow vascular malformations (LFVMs) as an alternative to surgical resection in adults; however, limited data of its use in a pediatric setting are available. The purpose of this study was to evaluate the efficacy and safety of sclerotherapy for pediatric LFVMs.. In this retrospective study, we reviewed our multidisciplinary vascular malformations team database for all patients younger than 18 years treated for congenital vascular malformations from 2008 to 2017. Of these, patients with LFVM treated with foam sclerotherapy were included. Dynamic contrast-enhanced magnetic resonance imaging was used to select patients for sclerotherapy by the multidisciplinary team. Foam sclerotherapy was performed with either polidocanol or sodium tetradecyl sulfate. Patients' characteristics, including demographics, presenting symptoms, and anatomic location of malformation, were assessed. Outcomes included treatment response, number of procedures, and postprocedural complications.. The 61 patients with 61 LFVMs included 27 boys (44.3%) and 34 girls (55.7%), with mean age of 10.3 years (standard deviation, ± 5.3 years). The cohort included 32 venous (52.5%), 16 lymphatic (26.2%), and 8 mixed venous and lymphatic (13.1%) malformations along with 5 (8.2%) associated with Klippel-Trénaunay syndrome. Primary indications for intervention included pain and swelling (n = 12 [19.6%]), pain alone (n = 23 [37.7%]), swelling alone (n = 15 [24.6%]), functional impairment (n = 8 [13.1%]), and bleeding (n = 3 [4.9%]). Anatomic distributions varied, with 13 head and neck (21.3%), 5 truncal (8.2%), 10 upper extremity (16.4%), 27 lower extremity (44.3%), and 6 diffuse (9.8%). Among the head and neck lesions, 8 (13.1%) extended to the face; and of the extremity lesions, 5 (8.2%) extended to the hand and 17 (27.9%) to the foot. Overall, sclerotherapy resulted in significant improvement or complete resolution of symptoms in 53 patients (86.9%). Complications were observed in seven patients (11.4%); six cases (9.8%) of superficial skin ulceration resolved without intervention, and one infection (1.6%) required antibiotics. No patients experienced adverse hemodynamic consequences or venous thromboembolism.. This series of pediatric LFVMs, the largest of its kind to date, demonstrates that sclerotherapy with foam-based agents effectively reduces symptoms with an acceptable rate of complications. Further study is needed to determine the optimal sclerosing agents for individual subsets of LFVMs in the pediatric population.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Databases, Factual; Female; Humans; Infant; Infant, Newborn; Male; Polidocanol; Regional Blood Flow; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate; Time Factors; Treatment Outcome; Vascular Malformations

Foam sclerotherapy is an effective treatment strategy for venous malformations. Both polidocanol (POL) and bleomycin are effective sclerosants; however, no studies have reported POL-bleomycin foam.. To introduce a method for producing POL-bleomycin foam and evaluate the stability of POL-bleomycin foam with bleomycin concentrations.. Group A: 2 mL of 1% POL + 8 mL of air; Group B: 2 mL of 1% POL + 3 U bleomycin + 8 mL of air; Group C: 2 mL of 1% POL + 6 U bleomycin + 8 mL of air; Group D: 2 mL of 1% POL + 12 U bleomycin + 8 mL of air. Tessari method was used for foam generation. The foam half-life time (FHT) was used to evaluate foam stability. Five recordings were made for each group.. The FHT was 148.6 ± 2.9 seconds in Group A, 148.8 ± 4.0 seconds in Group B, 148.4 ± 2.6 seconds in Group C, and 148.8 ± 1.6 seconds in Group D. The FHT in different groups showed no significant differences.. The POL-bleomycin foam was prepared successfully and its FHT was as long as the POL foam.

Topics: Bleomycin; Drug Combinations; Drug Compounding; Drug Stability; Half-Life; Humans; Polidocanol; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Veins

Venous malformations (VMs) are common slow-flow vascular malformations, which affect almost anywhere of the body. From January 2010 to October 2019, 126 patients with VMs who had complete imaging and follow-up data were enrolled into this study, including 75 males. The initial treatment age ranged from 5 to 72 years. The role of imaging results on the choice of treatment measures and the application were summarized. In this study, we retrospectively analyzed the imaging examinations, treatment measures, and follow-up results of the patients with VMs in our clinic. In this series, imaging examinations included ultrasound, magnetic resonance imaging, computed tomography (CT) scan and enhanced scan, percutaneous sinus angiography and three-dimensional CT imaging, plain film, CT venography, CT angiography, and digital subtraction angiography. Treatment measures included surgical excision (n = 20), sclerotherapy (n = 86, including absolute ethanol [n = 75], polidocanol [n = 8], and pingyangmycin [n = 3]), and combination treatment with intralesional copper wire retention and sclerotherapy(n = 20). After treatment, most of the lesions shrunk obviously or disappeared, and the symptoms were largely relieved. Comprehensive and accurate imaging assessment of VMs is necessary for selecting appropriate treatment. Individual strategy and sequential treatment can achieve effective results and avoid potential complications.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Humans; Male; Middle Aged; Phlebography; Polidocanol; Retrospective Studies; Sclerotherapy; Treatment Outcome; Vascular Malformations; Young Adult

The aim of the study was to assess the effectiveness of ultrasound-guided use of the foam form of ethoxysclerol for the treatment of venous malformations of the maxillofacial area. The study involved clinical and ultrasound examination data of 60 patient allowing to determine treatment tactics and optimal volume of injected foam sclerosant as well as the role of ultrasound for monitoring of the treatment. The results proved the efficacy of 3% foam ethoxysclerol for less invasive treatment of venous maxillofacial malformations.. Представлен опыт лечения 60 пациентов с венозными мальформациями (ВМ) челюстно-лицевой области (ЧЛО). Изучены возможности применения и обоснована целесообразность использования пенной формы этоксисклерола под контролем ультразвукового исследования (УЗИ) в лечении ВМ ЧЛО. На основании данных клинического обследования и результатов УЗИ определяли тактику и метод оптимального хирургического лечения, объем вводимого склерозанта в виде пенной формы. Дана оценка роли УЗИ для планирования и контроля эффективности проведенного лечения. Клинические наблюдения, подтвержденные данными УЗИ, показали, что методика контролируемого склерозирования 3% этоксисклеролом в пенной форме эффективна в лечении венозных мальформаций челюстно-лицевой области.

Topics: Face; Humans; Polidocanol; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

Percutaneous therapy with various sclerosants is an established treatment of venous malformations in general. We investigated the safety and effectiveness of polidocanol in the craniofacial region.. To present and evaluate our subjective and objective mid- and long-term results of patients with craniofacial venous malformations (CFVM) after percutaneous sclerotherapy using polidocanol.. Twenty patients with CFVM treated by percutaneous sclerotherapy were followed up and asked to fill in a questionnaire comparing levels of the following CFVM-related symptoms before and after treatment: pain; functional impairment; cosmetic deformities; and impairment in daily life. Additionally, both size reduction as well as procedural-related complication rates were analyzed.. Evaluation of the questionnaire revealed an improvement or complete relief of CFVM-related symptoms with significant reduced impairment in daily life after percutaneous sclerotherapy. Eighteen (90%) patients noticed a post-sclerotherapy improvement of at least one of their corresponding symptoms and expressed satisfaction with regard to their treatment. For 13 patients, a > 50% size reduction of the CFVM could be observed, while seven exhibited a < 50% size reduction. One minor complication was encountered in 56 treatment sessions (1.8%).. Percutaneous sclerotherapy using polidocanol is a well-tolerated treatment for CFVM with a low complication rate. Size reduction and positive results with improvement of different clinical symptoms can be achieved.

Topics: Face; Humans; Neck; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Surveys and Questionnaires; Treatment Outcome; Vascular Malformations

Several sclerosing agents are used to treat chronic venous diseases. Although they do not seem to differ in terms of efficacy, their safety profiles might differ.. To compare the safety profile of sclerosing agents through an analysis of the World Health Organization pharmacovigilance database.. The authors performed a disproportionality analysis using the proportional reporting ratio (PRR) method to compare pharmacovigilance signals between each sclerosing agent among 6 adverse event syndromes of interest: hypersensitivity reactions, arterial thromboembolic disorders, venous thromboembolic disorders, cardiac arrhythmias, visual/neurological disturbances, and skin ulcerations. The cutoff for signal detection was defined by a logPRR lower boundary 95% confidence interval (CI) ≥0 and number of cases n ≥3.. Of 1,227 Individual Case Safety Reports (ICSRs) identified, after removal of ICSRs with unselected indications, the authors selected 472 reports for the analysis. The authors found that polidocanol is associated with more reporting of venous embolic/thrombotic events (logPRR = 1.38 [95% CI 1.27-1.49]), ethanolamine with the higher pharmacovigilance disproportionality signal of cardiac arrhythmias (logPRR = 0.80 [95% CI 0.51-1.09]), and STS with more reporting of allergic reactions (logPRR = 1.79 [95% CI 1.59-1.98]).. The safety profile of sclerosing agents significantly differs and should guide benefit-risk ratio assessment of such agents.

Topics: Adverse Drug Reaction Reporting Systems; Databases, Factual; Drug-Related Side Effects and Adverse Reactions; Ethanolamine; Humans; Pharmacovigilance; Polidocanol; Risk Assessment; Sclerosing Solutions; Sodium Tetradecyl Sulfate; Telangiectasis; Varicose Veins; Vascular Malformations; World Health Organization

Until now, no study has focused exclusively on low-flow retrobulbar intraconal venous malformations (RIVMs) which may require treatment due to cosmetic defect, pain, and visual dysfunction. The treatment for RIVMs which surround the optic nerve remains challenging. This case series aimed to evaluate the technical feasibility, effectiveness, and safety of percutaneous sclerotherapy with polidocanol for low-flow RIVMs, using local anesthesia.. This is a prospective, non-comparative, single-center, interventional case series. All patients signed informed consent forms. Seven patients with RIVMs were treated with percutaneous sclerotherapy with polidocanol/air foam using CT guidance. Primary endpoints are reduction in the volume of RIVMs and pain relief assessed by visual analog scale (VAS). Secondary endpoints are exophthalmos and recording adverse events obtained in clinical follow-up during outpatient visits.. Results revealed that the mean volume of RIVMs was decreased from 12.05 ± 6.35 cm. The results of percutaneous intralesion injection of polidocanol for RIVMs are encouraging. The present results suggest that this method could be a safe and effective treatment option for patients with RIVMs.

Topics: Adolescent; Adult; Feasibility Studies; Female; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Radiography, Interventional; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome; Vascular Malformations; Young Adult

To evaluate clinical and imaging outcomes after ultrasound (US)-guided 3% polidocanol (POL) foam-sclerotherapy of venous malformations (VMs).. We retrospectively evaluated consecutive VM cases over 1.5 years, with 6-month follow-up. US findings were used to classify VMs into four types depending upon extent of anechoic channels, connections to adjacent veins, and dysmorphism. Single or multiple needles were inserted depending upon lesion size, and used to inject up to 8 mL POL per session, every 2 to 4 weeks. We evaluated reduction in pain and swelling, lesion resolution on imaging, and patient satisfaction.. There were 15, 24, 9, and 5 patients (total 53) with type I, II, III, and IV VMs, respectively. The average number of sessions was 5.3, 4.3, and 4, and the average amount of POL injected was 14.24 mL, 16.1 mL, and 23.2 mL for type I, II, III VMs, respectively. The number of sessions correlated with lesion volume (P < .0001). Imaging showed good resolution in 4/15, 18/24, 6/9, and 4/5 patients respectively with type I, II, III, and IV VMs. Patient satisfaction was not related to lesion type (P = .1). ROC analyses showed cut-off values of 4.9 mL lesion volume, three sessions, and 12 mL POL volume for patient satisfaction. At 6 months, 23 patients having pain had significant improvement (P < .00001). Local (n = 30) and chest pain (n = 2) were the only complications.. US-guided sclerotherapy with 3% POL foam is safe and effective. Lesions with up to 50% anechoic areas had better resolution, without correlation with patient satisfaction.

Topics: Adolescent; Adult; Child; Drug Administration Schedule; Female; Humans; Male; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Ultrasonography, Interventional; Vascular Malformations; Young Adult

Background Limited information is available on mid-term results and quality of life (QOL) after endovascular sclerotherapy of venous malformations. Purpose To compare two agents-polidocanol and ethanol-with a focus on the influence on QOL after sclerotherapy. Material and Methods Forty-one consecutive patients with a venous malformation in the head and neck area or in the extremities were treated with polidocanol between 2008 and 2013. Pre- and post-treatment magnetic resonance imaging (MRI) scans were compared. All patients completed a self-evaluation form on symptoms as well as a QOL questionnaire. The results were compared with previously obtained material during 1991-2001, comprising 44 consecutive, similarly located venous malformation patients subject to ethanol sclerotherapy. Results No significant clinical complications were observed. Subjectively, 19 (46%) of the patients benefitted from the treatment. QOL results showed that 85% of patients had an index < 39 - where 0 represents the highest and 100 the lowest QOL. Patients in the ethanol group had marginally better overall post-treatment QOL results. Post-treatment MRI in 35 patients showed the size of the malformation unchanged in 19 (54%) patients, in ten (29%) there was a decrease (<50%) while in six (17%) the decrease was more significant (>50%). Post-treatment MRI results did not correlate with either subjective symptoms or QOL results. Conclusion Polidocanol sclerotherapy were found to be an effective, safe, and well tolerated treatment option for low flow venous malformations. Routine MRI for follow-up appears redundant and may be omitted.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ethanol; Female; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Quality of Life; Sclerosing Solutions; Sclerotherapy; Solvents; Treatment Outcome; Vascular Malformations; Young Adult

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

Foam sclerotherapy is an effective treatment strategy for venous malformations (VMs). Stability is one of the characteristics of sclerosant foams that determine the sclerosing power.. To evaluate the clinical outcomes of sclerotherapy with prolonged half-life of hyaluronic acid (HA)-polidocanol (POL) foam for treating head and neck VMs.. Seventy patients with head and neck VMs were enrolled between October 2013 and January 2015 in Qilu Hospital Shandong University. Sclerotherapy was performed with prolonged half-life POL foam by addition of 0.05% HA. All patients were followed up at 1, 3, and 6 months. Reviews on the site and size of the lesion, times and duration of treatments, therapeutic response, and complications were performed to evaluate the end result.. Sites of lesions included face, bucca, parotid region, neck, tongue, floor of mouth, lip, forehead, palate, and nose. An overall average of 2.5 treatments was required. Total response rate was 100%. "Resolution" was achieved in 21 cases (30%) and a significant response in 49 patients (70%). Immediate swelling was the most common complication. Epidermal extravasation was seen in 1 patient. Mucosal ulcer was observed in 1 patient. No generalized complications occurred.. The prolonged half-life of HA-POL foam sclerotherapy of VMs in the head and neck is safe and effective.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Head; Humans; Hyaluronic Acid; Infant; Male; Middle Aged; Neck; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations

The aim of our study was to report our experience regarding the safety, efficacy of duplex-guided polidocanol (POL) foam sclerotherapy on the overall status of signs and symptoms in patients with venous malformations (VMs).. Thirty seven patients with symptomatic extratruncular VMs were treated with duplex-guided POL foam sclerotherapy using Tessari's method. Twenty five patients had limited VMs, while twelve had infiltrating VMs. Postsclerotherapy surveillance was done 6 months after the last sclerotherapy session and comprised both clinical and duplex evaluation. Clinical evaluation entailed a patient self-assessment questionnaire using a four-point scale to rate the degree of symptoms improvement as follows: disappeared, decreased, worsened, or recurred. Findings obtained by duplex scanning were divided into four groups: 1) disappeared group; 2) partially recanalized group; 3) totally recanalized group; and 4) worsened group.. There were 20 males and 17 females with mean age of 22.8±5.5 years. There was a significant reduction in the total amount of POL (P=0.0037), the number of sclerotherapy sessions was significantly lesser (P=0.0019), and treatment success was significantly higher (P=0.0495) in patients with limited VMs in comparison to those with infiltrating VMs. No major complications related to sclerotherapy were encountered in both groups.. Polidocanol foam sclerotherapy is effective, and safe for treatment of VMs, with high success rate and low risk of major complications. Although associated with relatively high recurrence rate compared with ethanol sclerotherapy, this can be overcome by additional treatment sessions, given the relative simplicity, speed, and safety.

Topics: Adolescent; Adult; Egypt; Female; Humans; Male; Pain; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Malformations; Veins; Young Adult

Sclerotherapy is one treatment option for head and neck venous malformations (VMs). Evaluation of complication risks is, however, essential to improve its safety. We aimed to systematically report sclerotherapy complications by means of the Clavien-Dindo classification and to distinguish factors predisposing to complications. We identified our institution's head and neck VM patients who received sclerotherapy between 1 January 2007 and 31 August 2013, analyzed patient reports retrospectively, and applied to them the Clavien-Dindo classification. Our 75 VM patients underwent a total of 150 sclerotherapy sessions. The most common sclerosants were 3 % sodium tetradecyl sulfate and polidocanol. Complications occurred in 13 patients (17.3 %) and in 15 sessions (10.0 %); 3 complications required extensive postprocedural treatment and caused permanent morbidity, whereas 12 received conservative treatment. Patients with sclerotherapy complications underwent more treatments (p = 0.009) and more often needed further surgery (p = 0.007). We thus consider sclerotherapy a relatively safe treatment modality for head and neck VMs. To avoid complications, evaluation of VM characteristics and optimal treatment technique in a multidisciplinary team is vital.

Topics: Adult; Female; Finland; Head; Humans; Male; Neck; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate; Treatment Outcome; Vascular Malformations; Veins

We have introduced and performed percutaneous sclerotherapy on pediatric patients, and information regarding the mid- and long-term results after percutaneous treatment of peripheral venous malformations is necessary to counsel patients and their parents about the outcome of the therapy. This study was designed to retrospectively evaluate the long-term satisfaction of pediatric patients following percutaneous sclerotherapy for venous malformations (VMs).. A total of 53 children younger than 16 years of age with VMs who underwent sclerotherapy were included in this study. Self-assessment questionnaires regarding the treatment effectiveness and patients' satisfaction were sent to 50 of 53 patients. Sclerotherapy was performed using 3% polidocanol, absolute ethanol, or 5% ethanolamine oleate (EO).. The median numbers of sessions per patient was 2.0 (range, 1-12), and the median follow-up time was 1.8 years (range, 6months-8.3years). Forty-two patients (84%) returned the questionnaire. The most frequent symptom was swelling (95%, 40/42) before sclerotherapy. After treatment, patients felt less pain (82%, 23/28), functional limitation (78%, 14/18), swelling (70%, 28/40), and cosmetic disfigurement (59%, 13/22). None of the patients responded "worse" for any symptoms, and 30 patients (71%) reported being "very satisfied" or "satisfied" with the treatment.. Percutaneous sclerotherapy of VMs was safe and effective for relieving symptoms in our pediatric patients, and many of them were satisfied with the outcomes.

Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Injections, Intralesional; Magnetic Resonance Imaging; Male; Patient Satisfaction; Phlebography; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Surveys and Questionnaires; Time Factors; Treatment Outcome; Vascular Malformations; Veins

Sclerosing foam is recommended to treat venous malformations (VMs). However, determining the precise dosage for satisfactory efficacy and few side effects are still challenging.. To develop a new method of preparing sclerosing foam by adding contrast agent to treat patients with VMs visibly and precisely under radiologic guidance.. Sclerosant (polidocanol) and contrast agent (iopromide) were mixed to prepare a new sclerosing foam according to Tessari method, and different ratios of the 2 materials were used to study the stability (half-life) of the produced foams. X-ray absorption of the radiopaque foams was observed during patient treatment with digital subtraction angiography (DSA).. The foams generated with the new method demonstrated a high x-ray absorption under DSA. The foam half-life among groups varied. The ratio of iopromide/polidocanol at 1:2 had a significantly longer half-life than the 1:1 or polidocanol-only group. The 1:2 group had a relative high x-ray absorption and was radiopaque to allow visualization of the sclerosing foam and lesion with DSA.. Mixing contrast agent with sclerosant to prepare radiopaque foams is a new method for treating complex VMs with DSA, and a ratio of 1:2 is recommend for polidocanol and iopromide.

Topics: Adult; Angiography, Digital Subtraction; Contrast Media; Drug Compounding; Female; Half-Life; Humans; Iohexol; Male; Middle Aged; Phlebography; Polidocanol; Polyethylene Glycols; Radiography, Interventional; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Veins; Young Adult

The current treatment for vascular malformations includes surgery, sclerotherapy, and embolization. However, each method has its limitations, such as recurrence, complications, scarring, and radiation exposure. Therefore, identifying an effective, minimally invasive treatment that reduces lesion recurrence is particularly important. We describe in detail a patient who received treatment with ultrasound-guided laser interruption of feeding vessels combined with polidocanol sclerotherapy after the recurrence of forearm high-flow vascular malformation.

Topics: Blood Flow Velocity; Child; Combined Modality Therapy; Female; Forearm; Humans; Laser Therapy; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Ultrasonic Therapy; Vascular Malformations

To investigate the safe and effective treatment for painful venous malformation (VM) in limbs.. (1) 97 cases with painful VM underwent MRI to detect the location of VM, as well as its size and structure, its relationship with the surrounding tissue. Statistical analysis was also performed. (2) The embolic agent (ethanol) was first injected to embolize the draining vessels of VM, then the Polidocanol plus Methotrexate (MTX) was followed to keep the embolization effect on VM. The therapeutic effect was observed and analyzed.. From January 2010 to January 2012, 97 patients with painful VM were treated. A Spearman correlation analysis showed no significant correlation between symptoms of pain and lesion growth, volume, or MRI grades (P > 0.05). The lesions in the muscle space are more likely to have the symptoms of pain (P < 0.01), followed by the lesions in the muscle, then the lesions in the joint and subcutaneous tissue. The pain relieve percentage was 95.9% (93/97) after one time embolic sclerotherapy. No severe complication, such as distant embolization, nerve damage, or muscle atrophy happened. No pain reoccurrence happened after 0.5-1.5 years of follow-up period.. The treatment of embolic scleratherapy is minimal invasive, safe and effective for painful VM with stable results.

Topics: Ethanol; Extremities; Humans; Methotrexate; Pain; Pain Management; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Statistics, Nonparametric; Vascular Malformations; Veins

We have reviewed our experience (15 patients during the period 2008-2012) in the treatment of low flow vascular malformations (LFVMs) of the face and oral cavity with polidocanol foam sclerotherapy. They were diagnosed clinically and with the help of Doppler ultrasound and magnetic resonance imaging. The maximum dose recommended for each session was 20mg/day and the minimum interval between sessions was 4 weeks. Embolisation was repeated as many times as needed until the size of the lesions and the symptoms had been reduced sufficiently. Patients were followed up 1, 6, and 12 months after treatment had finished, and the size of the lesions was assessed objectively. The 8 men and 7 women were aged between 18 and 71 (mean 44) years. The lesions had reduced and symptoms had improved in all cases. During the follow-up period, one patient relapsed and developed further symptoms. The pain and postoperative inflammation were successfully controlled with an analgesic and an anti-inflammatory drug. There was only one complication (superficial necrosis), which healed completely by second intention. Direct puncture and sclerosis with polidocanol foam are an effective treatment for LFVM of the face and oral cavity.

Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents; Embolization, Therapeutic; Face; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mouth Diseases; Pain, Postoperative; Polidocanol; Polyethylene Glycols; Punctures; Recurrence; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Tissue Adhesives; Treatment Outcome; Vascular Malformations; Young Adult

Venous malformations are the most common type of vascular malformation, usually detected at birth or during puberty. By occurring during human growth or through localized trauma, pain, functional impairment and aesthetic disfigurement is often observed. Ultrasonography, Doppler flow Imaging, and Magnetic Resonance Imaging are the most informative techniques which reveal the extent of tissue involvement and differentiate between high and low flow anomalies. Therapeutic options for treatment of venous malformations are sclerotherapy with alcohol, ethoxysclerol and bleomycin, laser therapy (Nd:YAG), surgery and combined therapeutic modalities. The aim of percutaneous sclerotherapy is the successive reduction of the volume of the lesion by aseptic inflammation.. This is a review of 51 patients with venous malformation treated by the Interdisciplinary Center for Vascular Anomalies at the University Hospital Tübingen, (Germany), from July, 2002 until January, 2007. The mean age of first consultation in our outpatient department was 26.4 years (median). 12 patients were treated by sclerotherapy with highly concentrated alcohol, 9 by surgery, and 7 by laser therapy. In some cases we combined different treatments. 9 patients had only sclerotherapy, while 3 had a combination of pre-operative sclerotherapy and surgery.. We obtained positive results in patients treated with sclerotherapy and combined sclerotherapy and surgery.. Sclerotherapy is safe (under fluoroscopic control), efficient, and can be repeated multiple times. Therefore, it should be considered as first-line treatment in venous malformations. A combination of a sclerotherapy with surgery is also useful in many cases.

Topics: Adolescent; Adult; Aged; Bleomycin; Child; Child, Preschool; Combined Modality Therapy; Ethanol; Female; Humans; Infant; Laser Therapy; Lasers, Solid-State; Magnetic Resonance Imaging; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Regional Blood Flow; Sclerosing Solutions; Sclerotherapy; Ultrasonography, Doppler; Vascular Malformations; Young Adult

We describe the benefits of an early surgical approach to large (more than 3 cm) venous malformations in the lower face, and discuss the advantages over conservative treatment. Fifty-eight patients with venous malformations of the lower face were treated in this hospital between 2005 and 2010 with sclerotherapy (lipidocanol), or láser, or resection, or all three. Only patients with recurrent malformations and a history of previously ineffective conservative treatment were included in the study (n=17). Follow-up ranged from 23-65 months (mean 40). Functional and cosmetic outcomes and recurrence were recorded on a single questionnaire. Seventeen patients with a history of recurrent malformations, which had previously been treated ineffectively with conservative treatment and were more than 3 cm in diameter, benefited from early and wide resection. No recurrences were recorded during follow-up. Patients were satisfied with the postoperative cosmetic and functional results. Large malformations are both deforming and functionally disabling. These patients, who initially do not respond to conservative treatment, benefit from early definitive resection.. 4 (case series with comparison).

Topics: Adolescent; Adult; Child; Child, Preschool; Chin; Combined Modality Therapy; Esthetics; Female; Follow-Up Studies; Humans; Laser Therapy; Lip Diseases; Male; Patient Satisfaction; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vascular Malformations; Young Adult

The minimally-invasive nature of sclerotherapy makes it one of the first treatment options for venous malformations, although treatment-related complications, such as peripheral nerve paralysis, have been reported in some clinical cases. However, no studies of the aetiology of the detrimental effects of intraluminally-administered sclerotic agents on the surrounding tissues, including the peripheral nerves, have yet been published. This study therefore investigated the influences of intraluminally-administered sclerotic agents on the tissues surrounding the injection site using a newly-developed rat femoral vein model. Using this model, the effects of absolute ethanol, 5% ethanolamine oleate, and 1% polidocanol were compared histologically with those of normal saline controls. Fluorescein isothiocyanate-conjugated agents were administered and the leakage of sclerotic agents through the venous wall was evaluated by fluorescence microscopy. Damage to the adjacent femoral nerve was quantitatively evaluated by counting the numbers of axons in cross-sections. All the sclerotic agents caused vascular wall injuries and leakage into the surrounding tissues. The number of axons in the femoral nerve was significantly reduced following administration of absolute ethanol or 5% ethanolamine oleate, compared with normal saline. The results of this study suggest that sclerotic agents commonly leak out the vascular lumen, and some agents can cause adjacent nerve injury. It is important to be aware of this type of complication of sclerotherapy for venous malformations when selecting appropriate therapeutic interventions.

Topics: Animals; Capillary Permeability; Endothelium, Vascular; Ethanol; Extravasation of Diagnostic and Therapeutic Materials; Femoral Nerve; Femoral Vein; Fluorescein-5-isothiocyanate; Injections, Intravenous; Microscopy, Electron, Scanning; Oleic Acids; Polidocanol; Polyethylene Glycols; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy; Vascular Malformations

To report the efficacy of percutaneous puncture and sclerosis using polidocanol in the treatment of venous malformations (VMs) in pediatric patients.. Between March 2007 and February 2011, a series of 19 patients with VMs on the upper and lower extremities had undergone a total of 89 sessions of intralesional sclerotherapy using polidocanol. All the procedures were performed in an angiographic suite under general anesthesia in order to maintain sedation for facilitating the procedure. For each injection, approximately 1 ml of 2% polidocanol was injected for each centimeter of the diameter of the lesion, with a maximum of 6 ml. Injection of the sclerosant was guided by real-time sonography and fluoroscopy.. After the treatment, the symptoms completely resolved in four patients (21%). Clinical symptoms, such as bulging and pain were improved in 12 out of 19 patients (63%). They remained unchanged in three patients (16%). During the procedures, no major complications were encountered. The minor complications (65%) encountered were swelling and pain after treatment which were resolved by taking NSAID within a few days.. In pediatric patients, sonographically guided percutaneous puncture and fluoroscopically guided sclerosis using 2% polidocanol is effective, less invasive and safe for the treatment of VMs, with a high success rate and minimal complications.

Topics: Adolescent; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Fluoroscopy; Follow-Up Studies; Humans; Injections, Intralesional; Lower Extremity; Male; Phlebography; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Tissue Adhesives; Treatment Outcome; Ultrasonography; Upper Extremity; Vascular Malformations; Veins

Topics: Aged, 80 and over; Anal Canal; Argon Plasma Coagulation; Capsule Endoscopy; Colonoscopy; Comorbidity; Epinephrine; Gastrointestinal Hemorrhage; Humans; Ligation; Male; Polidocanol; Polyethylene Glycols; Rectum; Recurrence; Sclerotherapy; Suture Techniques; Vascular Malformations

Venous malformations (VMs) involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult. Recently sclerotherapy has been suggested as the primary treatment for VMs instead of surgical intervention. This report represents eight cases of children with VMs treated with direct percutaneous injections of sclerosing agents, such as ethanol, polidocanol or ethanolamine oleate.. All eight patients had large lesions (>3 cm) located on the head, foot, neck and face. Sclerotherapy was performed in an angiographic suite under general anesthesia. Prior to sclerotherapy, percutaneous phlebography was performed in order to visualize the dynamic situation inside the lesion and the draining flow into the adjacent venous vascular system. A 2-15 ml of sclerosing agent was injected into VM lesions under fluoroscopy.. An evaluation by MRI examination showed that 6 out of 8 patients had remission, and alleviation of their symptoms without major complications, furthermore one of the lesions apparently disappeared. Intralesional sclerotherapy provides a simple, safe and effective treatment for VMs in the subcutaneous lesions in children.

Topics: Adolescent; Child; Child, Preschool; Ethanol; Female; Fluoroscopy; Humans; Injections, Intralesional; Magnetic Resonance Imaging; Male; Oleic Acids; Phlebography; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Veins