Percutaneous Ethanol Sclerotherapy Research Articles

Minimally invasive methods of treatment of single recurrent metastases in the lymph nodes of the neck of highly differentiated thyroid cancer

Papillary thyroid cancer is the most common type of cancer, which accounts for about 80—85% of malignant tumors of this organ. In 20—30% of patients, a relapse of the disease is detected after treatment. Repeated surgical intervention increases the likelihood of complications. Minimally invasive techniques give the possibility of effective ablation of individual metastases of the neck less traumatically and with lower costs. Objective — to evaluate the effectiveness of minimally invasive treatment methods of isolated recurrent metastases of highly differentiated thyroid cancer. Materials and methods. The study involved 34 patients with recurrent metastases of papillary thyroid cancer in neck lymph nodes. Patients were allocated into two groups depending on the use of minimally invasive methods: 31 underwent percutaneous ethanol sclerotherapy, three patients underwent laser‑induced interstitial thermotherapy. All patients underwent volume treatment: thyroidectomy, central and lateral neck dissection, lymphadenectomy followed by radioiodine therapy. Patients had solitary altered lymph nodes, metastases size <1.5 cm3, at a safe distance from main vessels, trachea, or esophagus, high risk of postoperative complications, and/or refused repeated surgical intervention. Results. Percutaneous ethanol sclerotherapy technique in 28 patients resulted in the decrease in thyroglobulin levels by 33.6% at average; antibodies to thyroglobulin by 15.3%, and remission of the disease, according to ultrasound results. In three patients, the growth of a metastatic lymph node with an increase in the level of thyroglobulin was noted, which indicates that the described method wasn’t sufficiently effective. The laser‑induced interstitial thermotherapy procedure was performed only in three patients, this small group does not allow conducting a reliable analysis of the treatment results. Positive clinical, laboratory and pathomorphological effect was obtained in all three cases. Conclusions. Minimally invasive techniques have no sufficient effectiveness in comparison with surgery, but they are effective enough for patients with a high risk of postoperative complications, anesthetic risk, and/or for those who refused to undergo repeated surgery.

Percutaneous ethanol sclerotherapy for the treatment of benign cystic thyroid nodules: A 5 year-experience at a tertiary care hospital

Percutaneous ethanol sclerotherapy for the treatment of benign cystic thyroid nodules: A 5 year-experience at a tertiary care hospital

Efficacy of single-session 99.5% ethanol sclerotherapy for incidentally found simple renal cysts

Simple renal cysts are the most common masses in the kidney. Most are asymptomatic and are incidentally detected on imaging examinations performed for other reasons. This study aimed to compare the results of 40 and 120 minutes ethanol sclerotherapies that were performed in a single session to treat incidentally found simple renal cysts. We retrospectively reviewed 63 renal cysts in 62 patients treated by single session percutaneous ethanol sclerotherapy. Thirty-one patients with 32 cysts underwent a 40 minutes sclerotherapy (group A), and 31 patients with 31 cysts underwent a 120 minutes retention technique (group B). Under ultrasonographic and fluoroscopic guidance, cystic fluid was completely aspirated, and 50% of the aspirated volume was replaced with 99.5% ethanol (a maximum of 100 mL). Imaging follow-up of the patients was performed 3 months after sclerotherapy. The technical success rates were 100% in both groups. Eighteen patients (29.0%) were symptomatic (flank pain or discomfort). Indications of the other patients were large cysts (>5 cm; 46%) and an increment in the diameter on serial studies (25.4%). A significant difference between the 2 groups in terms of age, cyst diameter, volume of aspirated fluid, volume of injected ethanol, and percentage of reduction in cyst diameter (P > .05) was not found. After treatment, flank pain or discomfort resolved in 17 of 18 (94.4%) symptomatic patients. One patient complained of persistent flank pain; however, no significant abnormality was detected on post-procedural computed tomography images. There were no other complications after therapy in the 2 groups. Single session ethanol sclerotherapy with a 40 minutes retention technique is an effective, safe, and cost-effective method for the treatment of incidentally found simple renal cysts. Although the procedural time was reduced, there was no significant difference in therapeutic efficacy between the 40 and 120 minutes therapies.

Minimally Invasive Treatment of Benign Thyroid Nodules

Background. Nodular goitre is the commonest pathology of thyroid gland. According to published evidence, the endemic prevalence of iodine deficiency varies within 19–76 % population. The high rates and lack of symptoms at progressive nodules growth warrant the development of effective organ-preserving treatments. Imaging techniques for local precision targeting of individual lesions enable maximum-preserving interventions at thyroid tissue. Today’s world experience of percutaneous ethanol sclerotherapy and radiofrequency ablation is adequate. However, there exist no clear indications for sclerotherapy and radiofrequency ablation, and their consecutive use has not been assessed.Materials and methods. We analyse minimally invasive organ-preserving treatments of benign thyroid nodules (ethanol sclerotherapy, RFA) in 63 patients at the outpatient and general surgery units of BSMU Clinic and MEGI Medical Centre, Ufa, during February 2019 — December 2020.Results and discussion. Ethanol sclerotherapy was highly effective in 46.5 % patients, as evident from discontinued nodule’s blood supply in CDI and B-mode ultrasound, which remained stable in 10.5 % and restored after 3–4 weeks in 25 % patients. Sclerotherapy in colloid goitre was efficient only in 37.5 % patients. Ethanol sclerotherapy was RFA-followed in 25.4 % patients. RFA was favoured at a low-effective sclerotherapy providing for a weak positive dynamics of nodule size, local parietal blood flow preservation and intranodular vessels recanalisation at re-examination.Conclusion. Sclerotherapy was high-effective in cystic nodules. Radiofrequency ablation can be considered most adequate for treating solid nodules. RFA-followed sclerotherapy is a rational choice in treatment of large cystic nodules (>5 cm3 ).

Digital subtraction angiography-guided ethanol sclerotherapy for peripheral venous malformation: A retrospective cohort study of single centre experience

IntroductionVenous malformations are the most common type of vascular malformations. Ethanol sclerotherapy is one of the most commonly used treatment methods. This study is to evaluate the initial results of digital subtraction angiography-guided ethanol sclerotherapy in patients with peripheral venous malformation. MethodsThis was a retrospective cohort study of a single centre experience. Patients diagnosed with peripheral venous malformation who underwent digital subtraction angiography-guided ethanol sclerotherapy from Jan 2017 to Jun 2021 were included in the study. Medical records were reviewed to record demographic information, lesion characteristics including clinical and magnetic resonance imaging findings, treatment sessions, therapeutic outcomes, and complications. ResultsA total of 104 patients were included. The mean number of procedures was 2.0 ± 1.3 times. Last follow-ups revealed a partial relief of symptoms in 97.2% of patients, and three patient (2.9%) showed no improvement. Post-treatment imaging revealed an overall objective response rate of 93.3%. Early post-procedural minor complications occurred after sclerotherapies in 31.7% of patients and were entirely resolved by conservative means. On multivariate analysis, poorly-defined margin (OR: 10.7, 95% CI: 2.28–76.9) and volume of venous malformation on MRI (OR: 1.04, 95% CI: 1.00–1.11) were independent predictors of “no-good response” to percutaneous ethanol sclerotherapy. ConclusionPercutaneous sclerotherapy is safe and effective in the treatment of venous malformation. A poor-defined margin and volume of VMs on MRI were statistically significant predictors of the initial percutaneous ethanol sclerotherapy results and may be useful in selecting patients.

Efficiency and safety of ethanol sclerotherapy for labial arteriovenous malformations

BackgroundLabial arteriovenous malformations (AVMs), usually with accompanying cosmetic defects, pain, and bleeding, are aggressive with a high risk of recurrence and the absence of effective treatment. In the present report, we have described a technique of sclerotherapy for labial AVMs. MethodsPatients with labial AVMs were treated with percutaneous ethanol sclerotherapy with or without polyvinyl alcohol particle embolization. The efficiency, complications, and recurrence rate were analyzed with imaging studies and clinical follow-up data. ResultsAll 15 patients had received one or more treatment sessions, of whom 8 had experienced a cure (53.3%) and 5 had experienced remission (33.3%). The two patients who had not experienced an effective result were awaiting further treatment at the last follow-up examination. Four patients (26.7%) who had undergone ethanol sclerotherapy combined with polyvinyl alcohol particle embolization had experienced recurrence. No patient who had undergone only sclerotherapy had developed recurrence at a mean follow-up of 17.2 ± 8.1 months. Thirteen patients had experienced transient complications, including swelling, mild bleeding, and blistering. One patient had a postoperative scar of ∼0.5 cm. ConclusionsEthanol sclerotherapy appears effective as a treatment of labial AVMs. Careful application of the treatment could reduce the occurrence of complications.

Percutaneous ethanol sclerotherapy is a promising treatment for recalcitrant angiolymphoid hyperplasia with eosinophilia

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular proliferation, which manifests as characteristic red nodules and papules, mostly located on the scalp and periauricular regions. Patients seek treatment for both aesthetic and functional reasons, as lesions may ulcerate, bleed and itch. Many therapeutic approaches have been reported, with variable success, and relapse remains a troublesome issue. The aim of this study was to report our experience treating ALHE using percutaneous ethanol sclerotherapy (PES). We present a retrospective case series of three patients treated with PES (1-2 treatment sessions each). All patients had tried and failed other treatments prior to this intervention, but following PES treatment, all patients demonstrated significant improvement, which was sustained at follow-up (range 8-17 months after first treatment). Adverse effects were tolerable and transient. This case series demonstrates PES as a promising treatment for recalcitrant ALHE.

多発性肝嚢胞に起因した門脈圧亢進症・肝性脳症の制御に経皮的嚢胞ドレナージ・硬化療法が有用であった1例

多発性肝嚢胞に起因した門脈圧亢進症・肝性脳症の制御に経皮的嚢胞ドレナージ・硬化療法が有用であった1例

Percutaneous ethanol sclerotherapy for auricular arteriovenous malformation: Our experience with 11 patients.

·Eleven consecutive patients with auricular AVMs were treated with percutaneous ethanol sclerotherapy. ·Percutaneous ethanol sclerotherapy was effective in all patients and, significantly, no clinical recurrence of the nidus was observed during follow-up. ·Our results suggest that ethanol sclerotherapy has the potential to cure auricular AVM.

A Painless and Time-Saving Modified Technique for Simple Renal Cyst Treatment with Single-session Ethanol Sclerotherapy

Percutaneous puncture ethanol sclerotherapy is a simple, effective, minimally invasive, and inexpensive procedure to manage symptomatic simple renal cysts. We modified specific technical aspects to balance certain potential intraprocedural factors for ensuring minimal procedural pain and duration as well as maximal clinical therapeutic effects and evaluated the safety and efficacy of this modified technique. A total of 84 eligible patients underwent computed tomography-guided single-session ethanol sclerotherapy using the conventional (group A) or modified (group B) technique. In group B, the puncture route was modified from tansparenchymal to direct for reducing renal injury, and preinjection of low-dose intracystic lidocaine was used to control distending pain caused by ethanol injections; therefore, greater ethanol volumes could be injected for improving the resistance and contact of ethanol with the cyst wall, precluding the need for patient repositioning multiple times to decrease procedural duration. Visual analog scale score for pain and procedural time were significantly higher in group A than in group B. The complication rate was slightly higher in group A than in group B, but the success rate was comparable between the two groups. These results suggest that the modified technique is painless, time-saving, and injury-reducing and can thus improve medical care.

Percutaneous ethanol injection efficacy in the treatment of benign thyroid nodules. Ten-year follow-up of 254 patients

Introduction and aim: Although percutaneous ethanol sclerotherapy for the treatment of benign thyroid nodules (PEI) has been used for more than 30 years, there are only two studies in thyroid cysts (THCY) and 2 in autonomously functioning nodule (AFN) in which the mean follow-up reaches at least five years, while in the event of non-autonomously functioning solid nodules (NAS), there is not any study with at least 5-year mean follow-up. Our study focuses on the long-term efficacy of PEI in benign thyroid nodules. Method: We analyzed the long-term success of PEI in 254 patients treated for more than 10 years. The success was defined as 50% or greater reduction in nodule volume. In addition, the patient had to remain euthyroid without thyrostatic therapy in AFN. Results: The 10-year success rate was 79.4%, 37.1% and 69.4% in THCY, AFN and NAS, respectively. In 23.3% of unsuccessful PEIs, the failure could be revealed only after 5 years of follow-up. The mean nodule volume at 10-year follow-up related to the initial size was 29.8%, 39.6% and 48.9% in THCY, NAS and AFN, respectively. In THCY, PEI proved to be significantly more effective in older patients while other parameters (size of the nodule, amount of the injected alcohol and the ratio of these) did not correlate significantly with the success rate. Conclusions: Our study which presents the longest follow-up in all 3 types of benign thyroid nodules confirms that PEI has a minimal role in AFN, is recommendable in THCY and might have a role in NAS. The success rate decreases over time which emphasizes the importance of the long-term follow-up in the judgement of PEI. Orv Hetil. 2020; 161(6): 224-231.

A Novel Technique in the Treatment of Lymphoceles After Renal Transplantation: C-Arm Cone Beam CT-Guided Percutaneous Embolization of Lymphatic Leakage After Lymphangiography.

We aimed to evaluate the efficacy of percutaneous embolization after lymphangiography using C-arm cone-beam computed tomography (CBCT) performed at the site of lymphatic leakage in patients with postrenal transplant lymphocele. Between July 2014 and August 2017, 13 patients not responding to percutaneous ethanol sclerotherapy and conservative treatment for recurrent lymphocele after renal transplant were included. The mean age of the patients was 56.38 ± 9.91 (range, 36-70) years, and it comprised 9 men and 4 women. All patients underwent intranodal lymphangiography. C-arm CBCT-guided percutaneous embolization was performed in patients with confirmed lymphatic leakage. Patients who had no lymphatic leakage underwent drainage with fibrin glue injection. Lymphatic leakage was observed in 9 patients after lymphangiography, and they underwent CBCT-guided percutaneous N-butyl-2-cyanoacrylate embolization. The volume of lymphatic drainage reduced to less than 10 mL in 8 patients. One patient who was not responding to embolization was treated surgically, after percutaneous drainage and fibrin glue injection. Lymphatic leakage was not observed in 4 patients after lymphangiography. Of these, 3 patients showed a reduction in the amount of lymphatic drainage after lymphangiography. All 4 patients underwent percutaneous drainage and fibrin glue injection. One patient did not respond to the treatment and was treated surgically. Prelymphangiography and postlymphangiography and embolization, the volume of lymphatic drainage was 113.07 ± 21.75 mL, and 53.84 ± 30.96 mL, respectively, and statistically significant decrease was detected (P < 0.005). Lymphangiography and CBCT-guided percutaneous embolization procedures might be an effective treatment method for patients with lymphocele refractory to treatment.

Abstract No. 704 Single-session 99.5% ethanol sclerotherapy for simple renal cysts: comparison of 40- and 120-minute retention techniques

To compare the results of 40- and 120-minute ethanol sclerotherapies which were performed in a single session for the management of simple renal cysts. We retrospectively reviewed 63 renal cysts in 62 patients treated by single-session percutaneous ethanol sclerotherapy. Thirty-two cysts in 31 patients underwent 40-minute sclerotherapy (group A) and 31 cysts in 31 patients underwent 120-minute retention technique (group B). Under ultrasonographic and fluoroscopic guidance, the cystic fluid was completely aspirated and 50% of the aspirated volume replaced with 99.5% ethanol (maximum, 100 mL). Follow-up of the patients were performed with ultrasonography or computed tomography (CT) at 3 months after sclerotherapy. Overall, technical success rates were 100% in both two groups. Eighteen patients (28.6%) were symptomatic (flank pain or discomfort). Indications of the other patients were large cyst (>5cm; 46%) and increment of the diameter on serial studies (25.4%). There was no significant difference between the two groups in terms of age (62.22 vs. 62.48 years), cyst diameter (8.43 vs. 8.14 cm), volume of aspirated fluid (230.06 vs. 250.16 mL), volume of injected ethanol (77.81 vs. 70.48 mL), and percentage of decrement of cyst diameter (58.6 vs. 53.67%) (P>0.05). After the treatment, flank pain or discomfort resolved in 17 (94.4%) of 18 symptomatic patients. One patient complained persistent flank pain, but no significant abnormality was detected on post-procedural CT images. There were no other complications after therapy in two groups. Single-session ethanol sclerotherapy with 40-minute retention technique is an effective and safe method for the treatment of simple renal cysts. It can reduce the procedural time and length of hospital stay, but there is no statistical difference in therapeutic efficacy between 40- and 120-minute therapies.

Percutaneous Ethanol Sclerotherapy of Venous Malformations of the Oral Cavity and the Oropharynx

Percutaneous Ethanol Sclerotherapy of Venous Malformations of the Oral Cavity and the Oropharynx

Long-term follow-up of large symptomatic hepatic cysts treated by percutaneous ethanol sclerotherapy.

As a minimally invasive treatment, ethanol sclerotherapy has been used for large symptomatic hepatic cysts, but there are not many long-term reports on treatment outcomes and safety. To evaluate the long-term outcomes of percutaneous ethanol sclerotherapy in patients with large symptomatic hepatic cysts. This study included 43 symptomatic, enlarging hepatic cysts in 42 patients who had undergone ethanol sclerotherapy from 2003 to 2013 and were followed up for >1 year. The treatment outcomes were evaluated in terms of the reduction of cyst size and resolution of symptoms. The patients were followed up for a mean period of 33 months with either ultrasound or computed tomography examination. Thirty-nine hepatic cysts (91%) were successfully treated with ethanol sclerotherapy, showing resolution of symptoms and remarkable reduction in cyst volume. Eight hepatic cysts (19%) disappeared completely, and 31 hepatic cysts (72%) decreased in size during the follow-up period. The mean diameter of the cysts decreased from 12.5 ± 4.4 cm to 3.8 ± 3.4 cm during follow-up. There were no immediate serious complications related to the procedure. There were four cases (9%) of treatment failure requiring subsequent surgical procedures. Percutaneous ethanol sclerotherapy can be considered as an effective first-line treatment for large symptomatic hepatic cysts.

Effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts.

We aimed to evaluate the effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts. From January 2002 to January 2014, 35 simple breast cysts (mean volume, 8.2 mL; range, 4-33 mL) in 28 females (mean age, 39 years) were evaluated. In a single session, all cysts were aspirated using 20G needles, refilled with 99% ethanol (90% of the volume of the aspirated fluid), and reaspirated completely after 10 minutes of exposure under ultrasound guidance. Follow-up ultrasonography examinations were performed at one week, one month, three months, and six months for all patients and 12 months, 18 months, and 24 months for available patients. Follow- up duration varied between 6 and 24 months (mean, 15 months). The technical success rate of ultrasound-guided percutaneous etha-nol sclerotherapy was 97%. The needle tip was dislocated and ethanol was given into the breast parenchyma in one patient (3%). One cyst (3%) was reaspirated at the first week follow-up due to intracystic hemorrhage. Of the 34 cysts treated, 25 (74%) completely responded to therapy and were no longer detectable on follow-up examinations. Eight cysts (24%) significantly decreased in size and then completely disappeared at six months. At the end of the follow-up period, the clinical success rate reached 100%, and none of the cysts were visible. Except mild to moderate sensation of burning or pain which disappeared or subsided significantly in a couple of minutes, no other complications were observed in patients. Ultrasound-guided ethanol sclerotherapy is a fast, safe, and highly effective method in the treatment of simple breast cysts.

52 The comparison of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts

52 The comparison of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts

Percutaneous Ethanol Sclerotherapy for Recurrent Adventitial Cystic Disease of External Iliac Vein after Surgical Treatment: A Case Report

Adventitial cystic disease (ACD) is an uncommon condition that accounts for only 0.1% of all vascular disease (1), and it mainly affects young men with intermittent claudication. It is most commonly seen in the popliteal artery, but it has also been reported in the external iliac, femoral, ulnar and radial arteries. Very few reports of this disease have been described in the venous system such as the common femoral vein, the popliteal vein, the wrist area veins, the lesser saphenous vein and the external iliac vein (2). Surgery has been known to be a standard therapy for this disease. Also there have been reports about less invasive technique such as percutaneous aspiration and angioplasty. However, several recurrences have been reported in these less invasive therapies (3). To the best of our knowledge, there is no report about management of recurrent ACD after surgery with percutaneous drainage and use of absolute ethanol as sclerosis agent. Here we report a case of successful treatment by percutaneous drainage and ethanol sclerotherapy for recurrent ACD of left external iliac vein that was previously treated by cyst excision and patch angioplasty.

Percutaneous Ethanol Sclerotherapy of Symptomatic Nodules Is Effective and Safe in Pregnant Women: A Study of 13 Patients with an Average Follow-Up of 6.8 Years.

Background. Because of the increased risk of surgery, thyroid nodules causing compression signs and/or hyperthyroidism are concerning during pregnancy. Patients and Methods. Six patients with nontoxic cystic, four with nontoxic solid, and three with overt hyperthyroidism caused by toxic nodules were treated with percutaneous ethanol injection therapy (PEI). An average of 0.68 mL ethanol per 1 mL nodule volume was administered. Mean number of PEI treatments for patients was 2.9. Success was defined as the shrinkage of the nodule by more than 50% of the pretreatment volume (V0) and the normalization of TSH and FT4 levels. The average V0 was 15.3 mL. Short-term success was measured prior to labor, whereas long-term success was determined during the final follow-up (an average of 6.8 years). Results. The pressure symptoms decreased in all but one patient after PEI and did not worsen until delivery. The PEI was successful in 11 (85%) and 7 (54%) patients at short-term and long-term follow-up, respectively. Three patients underwent repeat PEI which was successful in 2 patients. Conclusions. PEI is a safe tool and seems to have good short-term results in treating selected symptomatic pregnant patients. Long-term success may require repeat PEI.

Clinical Manifestations of Symptomatic Hepatic Cysts and Ethanol Sclerotherapy

Background : Most hepatic cysts are asymptomatic liver disease. Rarely, hepatic cysts will be symptomatic because ofincreasing size, infection and hemorrhage. We describe clinical characteristics of symptomatic hepatic cysts and its effectivetreatment.Methods : We performed a retrospective review of all patients diagnosed with symptomatic hepatic cysts between May 2009and April 2013 in Jeju National University Hospital. Twenty one symptomatic hepatic cysts (mean 10.7cm) in 14 patients (12women and 2 men, aged 51 to 81 years) were enrolled.Results : Symptoms of hepatic cysts were right upper abdominal pain (10 patients), recurrent lower extremities edema (2patients), fever (3 patients), and right shoulder radiating pain (1 patient). All symptomatic hepatic cysts were treated withpercutaneous drainage (mean volume 480 ± 325 ml, max 1250 ml). Three infected cysts were diagnosed by cystic fluidanalyses and treated using antibiotics. After drainage, 20 hepatic cysts were treated with 99.9% ethanol sclerotherapy for threedays. There were few minor complications including pain, nausea, vomiting. During follow-up (11 months), there was norecurrence. The mean diameter of remained cysts decreased to 3.2 cm with an average volume reduction rate of 92.3 % (from464.1 cm3 to 35.8 cm3).Conclusions : Percutaneous drainage and ethanol sclerotherapy is a very effective and safety treatment method ofsymptomatic hepatic cysts.