Subcutaneous Injection of Normal Saline Prevents Cutaneous Complications of Ethanol Sclerotherapy for Superficial Vascular Lesions: An Experimental Study

Abstract

Percutaneous sclerotherapy is an effective therapeutic option for the treatment of venous malformations. Absolute ethanol is used as a sclerotic agent because of its effectiveness but is often avoided for treatment of superficial lesions because of the possible risk of cutaneous necrosis. A preclinical experimental study was performed to validate whether the cytotoxic effects of ethanol on surrounding healthy tissues could be diminished with prophylactic subcutaneous injection of normal saline above the vascular lesion immediately after intraluminal injection of ethanol by dilution. The effect of normal saline dilution on cytotoxicity of ethanol to the main cells of the skin (fibroblasts and keratinocytes) were assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide colorimetric assay. Effects of subcutaneous injection of normal saline immediately after intraluminal ethanol injection were assessed in a newly developed animal experimental model using the rabbit auricular vein. Cytotoxic effects of ethanol were decreased by saline dilution in vitro. Subcutaneous injection of normal saline after intraluminal injection of ethanol prevented the cutaneous ulceration observed in all cases without subcutaneous injection of normal saline in our animal model. Subcutaneous injection of normal saline appears effective for preventing cutaneous complications after ethanol sclerotherapy for superficial vascular lesions.