Percutaneous Sclerotherapy Research Articles

Doxycycline Sclerotherapy of Mandibular Aneurysmal Bone Cysts: A Brief Clinical Study

Aneurysmal bone cysts (ABCs) are benign bone tumors typically affecting children. Mandibular ABCs can be difficult to treat surgically, given their sensitive anatomic location and functional and cosmetic impacts. This report presents 3 pediatric patients with mandibular ABCs successfully treated with image-guided percutaneous doxycycline sclerotherapy. The first 2 patients presented with pain and swelling, whereas the third was diagnosed incidentally. Sclerotherapy was the sole treatment for cases 1 and 2, whereas case 3 had sclerotherapy after recurrence following prior surgeries. In all 3 patients, clinical symptoms resolved, and stable bone healing was documented on long-term follow-up. There were no functional or cosmetic complications. Doxycycline sclerotherapy is a safe and viable treatment for primary and recurrent mandibular ABCs.

A neonate in emergency for giant auricular and cervical lymphatic malformations: Ultrasound‐guided percutaneous bleomycin sclerotherapy may be a choice

A neonate in emergency for giant auricular and cervical lymphatic malformations: Ultrasound‐guided percutaneous bleomycin sclerotherapy may be a choice

Symptomatic Simple Renal Cysts Treated with Percutaneous Sclerotherapy: Long-term Results

Background: Simple cysts are the most common lesions in the kidney and symptomatic patients require treatment. This study evaluates the use of single-sitting percutaneous sclerotherapy with needle aspiration under ultrasound (US) guidance in patients suffering from symptomatic simple renal cysts. Materials and Methods: Twenty-four patients suffering from symptomatic simple renal cysts during the period January 2018 to January 2020 underwent needle aspiration followed by sclerotherapy under ultrasound (US) guidance. Sclerotherapy with 30 mg sodium tetradecyl sulfate (STDS) was performed after aspiration of the renal cysts. A total of 28 symptomatic simple renal cysts in 22 patients were included in the study, two patients were lost for follow-up. The follow-up period was 48 months. Results: The diameter of the renal cysts ranged between 5.5 and 8.5 cm (mean: 6.24 ± 1.05 cm), and between 0 and 4 cm (mean: 0.286 ± 0.004 cm) before and after sclerotherapy, respectively (P < 0.001). The average diameter reduction was 92.16% during the follow-up period of 48 months. Flank pain was resolved in all the patients (100%). The procedure was termed “success” with all the patients. The three cysts in which, the reduction of size was <75% were more than 8 cm in initial size, and in one case, it was bilateral renal cysts. In these cases also, the pain was reduced completely and did not require any further treatment. We did not observe any procedure-related complications. Conclusion: Single-sitting needle aspiration with sclerotherapy using STDS under US guidance is an effective and safe method for treating symptomatic simple renal cysts.

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.

Fibroadipose Vascular Anomaly: Diagnosis and Treatment

Fibro-Adipose Vascular Anomaly (FAVA) is a recently identified type of vascular malformation predominantly affecting adolescent females. Comprising abnormal adipose and vascular components, FAVA is frequently misdiagnosed as other vascular anomalies. It primarily manifests with pain, functional impairment, and musculoskeletal symptoms, particularly in the lower extremities. Accurate diagnosis requires a combination of clinical, radiologic, and histopathologic evaluation, with MRI and ultrasound being the primary imaging tools. Management of FAVA is multidisciplinary and tailored to individual patients. Interventional radiology procedures, such as percutaneous cryoablation, sclerotherapy, and embolization, are effective in long term control of symptoms. Cryoablation is particularly successful in alleviating pain and improving function. Surgical resection is reserved for specific cases with extensive lesions involving joints or when there is severe muscle or joint dysfunction. Additionally, sirolimus, an mTOR inhibitor, has shown promise in symptom relief, although further research is needed to confirm its long-term efficacy. Early diagnosis and treatment are essential for improving the quality of life in FAVA patients. Advances in imaging and treatment strategies have enhanced the ability to manage this complex and rare condition effectively.

Conversion of the primary aneurysmal bone cyst into osteogenic sarcoma following treatment with percutaneous sclerotherapy using polidocanol injection

Conversion of the primary aneurysmal bone cyst into osteogenic sarcoma following treatment with percutaneous sclerotherapy using polidocanol injection

Percutaneous Sclerotherapy of Venous Malformations

Venous malformation (VM) stands as the most prevalent form of vascular malformation, characterized by its diverse morphology. These lesions can manifest in any part of the body, affecting different tissue planes and giving rise to symptoms such as pain, swelling, or physical dysfunction. In the realm of treatment, direct puncture VM embolization holds its place as the primary approach. This technique involves the administration of an embolization agent into the VM channels during contrast phlebography while simultaneously managing the outflow veins through different methods. The process of VM embolization induces endothelial damage, thrombosis, and fibrosis, resulting in symptom relief through lesion shrinkage. It is crucial to exercise caution techniques and embolization agents during VM embolization to minimize procedural complications, enhance clinical outcomes, and ultimately improve the patient's overall quality of life.

Whole-lesion assessment of volume and signal changes after sclerotherapy of extremity venous malformations

PurposeTo investigate quantitative changes in MRI signal intensity (SI) and lesion volume that indicate treatment response and correlate these changes with clinical outcomes after percutaneous sclerotherapy (PS) of extremity venous malformations (VMs). MethodsVMs were segmented manually on pre- and post-treatment T2-weighted MRI using 3D Slicer to assess changes in lesion volume and SI. Clinical outcomes were scored on a 7-point Likert scale according to patient perception of symptom improvement; treatment response (success or failure) was determined accordingly. ResultsEighty-one patients with VMs underwent 125 PS sessions. Treatment success occurred in 77 patients (95 %). Mean (±SD) changes were –7.9 ± 24 cm3 in lesion volume and –123 ± 162 in SI (both, P <.001). Mean reduction in lesion volume was greater in the success group (–9.4 ± 24 cm3) than in the failure group (21 ± 20 cm3) (P =.006). Overall, lesion volume correlated with treatment response (ρ = –0.3, P =.004). On subgroup analysis, volume change correlated with clinical outcomes in children (ρ = –0.3, P =.03), in sodium tetradecyl sulfate–treated lesions (ρ = –0.5, P =.02), and in foot lesions (ρ = –0.6, P =.04). SI change correlated with clinical outcomes in VMs treated in 1 PS session (ρ = –0.3, P =.01) and in bleomycin-treated lesions (ρ = –0.4, P =.04). ConclusionsChange in lesion volume is a reliable indicator of treatment response. Lesion volume and SI correlate with clinical outcomes in specific subgroups.

Image-Guided Percutaneous Sclerotherapy for Orbital Low-Flow Malformation: Our Experience.

For a safe sclerotherapy session to be completed in the orbital low-flow malformation (namely lymphovenous malformation or venolymphatic malformation), accurate identification of the target lesion for the drug injection is crucial. Regarding the dependability and viability of the injection approach, the authors have discussed their experiences with image-guided percutaneous sclerotherapy on a few patients.

A New Radiological Scoring System as a Method of Assessing Sclerotherapy Treatment Response for Aneurysmal Bone Cysts: A Retrospective Study.

Background A widely accepted set of imaging criteria or classification has not yet been adopted to evaluate response to treatment by percutaneous sclerotherapy for aneurysmal bone cyst (ABC). In this article, we described and illustrated the Royal Orthopaedic Hospital (ROH) scoring system which is a new, reproducible, and objective tool to evaluate the radiological response. We also reported our institutional experience in the efficacy of computed tomography (CT)-guided sclerotherapy for treating such lesions. Patients and Methods A retrospective analysis was conducted for 19 patients who underwent CT-guided sclerotherapy with doxycycline and albumin to treat ABC. Follow-up magnetic resonance imaging, at a minimum of 12 months, was assessed according to the four ROH scoring system parameters: cystic component, fluid-fluid level, presence of consolidation, and cortical integrity. The cumulative score was used to grade response as either: excellent, good, equivocal, or poor. Results Out of 19 patients with a mean age of 17.8 years, 11 cases occurred in the long bones, 5 cases in the pelvis, and 1 in each of the C3 vertebral body, scapula, and talus. The mean parameter of response score for cystic component was 2, fluid-fluid level was 1.3, consolidation was 2, and cortical integrity was 2.1. Four cases showed excellent response, 12 cases showed good response, 2 cases showed equivocal response, and 1 case showed poor response. Interrater reliability was excellent (κ = 0.9). Conclusion The ROH scoring system provides the radiologist and surgeon with an objective method to score imaging parameters of response independently and achieve a grade based on the cumulative score.

Abstract No. 533 Percutaneous Sclerotherapy of Lower Body Lymphatic Malformations with Intraosseous Involvement: A Report of Three Cases

Abstract No. 533 Percutaneous Sclerotherapy of Lower Body Lymphatic Malformations with Intraosseous Involvement: A Report of Three Cases

Sclerotherapy of the Post renal Transplant Lymphoceles: A Meta-Analysis

PurposeThis study evaluates the effectiveness of sclerotherapy in treating lymphoceles after kidney transplantation, focusing on factors such as recurrence rates and procedural success. Materials and MethodsRetrospective studies using sclerotherapy as the only form of treatment for post renal transplant lymphoceles were included. All studies used percutaneous transcatheter sclerotherapy as treatment and the success rate of the intervention was recorded. MEDLINE, Embase, and Cochrane Library databases for retrospective research studies that included the keywords “sclerotherapy post renal transplant lymphoceles” were used. 61 references were obtained by manually searching MEDLINE (n=20), Embase (n=41) and Cochrane Library (n=0). After removing 3 duplicates, 50 of the remaining articles were excluded after screening and the remaining studies were extracted for demographic data as well as our primary outcome of success rate of sclerotherapy. ResultsA descriptive analysis of the outcomes and complication rates associated with sclerotherapy interventions for lymphoceles is provided. A high degree of variation across the different studies was uncovered. According to the Kruskal-Wallis test, there was no correlation between the sclerosant used and the sclerotherapy complication rate (p = 0.472) or the success rate (p = 0.591). There was also no correlation between the sex of the patient and the success rate, however there was a significant difference in the complication rate by sex (p < 0.005). ConclusionIn conclusion, different sclerosant products have been used for therapy with no consensus on the most efficacious product as the success rate has been variable. In addition, the sex of the patient may have an influence on the complication rates associated with sclerotherapy for lymphoceles in post-kidney transplant patients.

Deep Vein Thrombosis of Saphenous-Femoral Junction After Leg Lauromacrogol Foam Ultrasound Guided Percutaneous Sclerotherapy

Background: Lauromacrogol foam sclerotherapy is characterized by a high success rate in obliterating varicose veins and a low frequency of adverse effects. Most of these parts consist of minor effects, and few data are available about significant effects (e.g., vein thrombosis), pointing out the technical safety of ultrasound-guided foam sclerotherapy.Case Presentation: a 78-year-old woman was evaluated for chronic vein disease; at ultrasonographic and Doppler scan (USDS), severe GSV dilatation and GSV reflux were documented in both legs below the knee. After meticulous anamnesis and physical examination, informed consent was obtained, and ultrasound-guided percutaneous polidocanol foam (one part of 2% lauromacrogol solution + one part of the air, mixed with Double Syringe System) sclerotherapy was performed in the right leg; best medical therapy was given after the procedure. After five days, USDS pointed out thrombosis extending to the thigh upper region to saphenous-femoral junctions, consisting of deep vein thrombosis. Appropriate anticoagulant therapy was promptly dispensed, and the patient had no aftermaths.Conclusion:The prevalence of vein thrombosis after lauromacrogol sclerotherapy is unknown, and their correlation is uncertain, but, in our experience, it should be suspected in patients who referred lower limb pain after this procedure despite the best medical therapy dispensation.

Percutaneous microwave ablation versus sclerotherapy for large hepatic hemangioma: a multi-center cohort study

Objective The study aimed to compare the effectiveness and safety of ultrasound-guided microwave ablation (MWA) and percutaneous sclerotherapy (PS) for the treatment of large hepatic hemangioma (LHH). Methods This retrospective study included 96 patients who underwent MWA (n = 54) and PS (n = 42) as first-line treatment for LHH in three tertiary hospitals from January 2016 to December 2021. Primary outcomes were technique efficacy rate (volume reduction rate [VRR] > 50% at 12 months), symptom relief rate at 12 months and local tumor progression (LTP). Secondary outcomes included procedure time, major complications, treatment sessions, cost and one-, two-, three-year VRR. Results During a median follow-up of 36 months, the MWA group showed a higher technique efficacy rate (100% vs. 90.4%, p = .018) and symptom relief rate (100% vs. 80%, p = .123) than the PS group. The MWA group had fewer treatment sessions, higher one-, two- and three-year VRR, lower LTP rate (all p < .05), longer procedure time and higher treatment costs than the PS group (both p < .001). MWA shared a comparable major complications rate (1.8% vs. 2.4%, p = .432) with PS. After multivariate analysis, the lesion’s heterogeneity and maximum diameter >8.1 cm were independent risk factors for LTP (all p < .05). In the PS group, lesions with a cumulative dose of bleomycin > 0.115 mg/cm3 had a lower risk of LTP (p = .006). Conclusions Both MWA and PS treatments for large hepatic hemangioma are safe and effective, with MWA being superior in terms of efficacy.

Indications, Outcomes, Efficacy, and Complications of Percutaneous Sclerotherapy in the Management of Hemangiomas at Kenyatta National Hospital

Background The effective management of hemangiomas using percutaneous sclerotherapy optimizes desired clinical outcomes and minimizes the associated complications in affected patients. Intra-lesional sclerotherapy involves injecting a sclerosing agent (such as bleomycin and sodium tetradecyl sulfate) into a lesion or the interstitial space around the lesion, causing endothelial injury, thrombosis, inflammation, scarring, and shrinkage of the lesion. Extensive literature suggests that sclerotherapy has a role in the management of hemangiomas, as demonstrated by better health outcomes and improved quality of life among affected patients. Objectives To evaluate the indications, outcomes, efficacy, and complications of percutaneous intra-lesional sclerotherapy in the management of hemangiomas. Materials and methods The study was a prospective cross-sectional study, conducted at a level 6 National Referral Hospital Interventional Radiology Unit. Patients with hemangiomas referred for intralesional sclerotherapy were treated. Data including the indications of intra-lesional sclerotherapy, short-term outcomes, complications were collected, analyzed, and presented in percentages, graphs, pie charts, tables. Technical and clinical success rates were calculated. The efficacy of intralesional sclerotherapy was analyzed using chi-square test. Results A total of 20 patients with hemangiomas were treated. There were 11 females comprising 55% and 9 males comprising 45% with a male to female ratio of 1:1.2. The commonest indication for referral was pain (21.6%), followed by abnormal swelling (18.9%). Most lesions were located in the liver comprising 25%. Other locations included the hand, cheek, lower lip, lower extremities (calf, distal leg, foot, and thigh), lumbar region, posterior thoracic back region and abdomen mesenteric region. Majority of the patients had significant improvement of clinical symptoms with a p-value &lt;0.05. Similarly, there was a statistically significant reduction in the sizes of the lesions treated with a p-value of &lt;0.05. The technical success rate was 100% and the overall clinical success rate was 90%. Mild pain (10%), mild edema (10%) and skin discoloration (5%) were the commonest minor complications encountered, with no major complications. Conclusion Percutaneous intralesional sclerotherapy is a safe and efficacious treatment of hemangiomas with a high technical and clinical success rate. It should be considered as a first line of treatment for the hemangiomas.

Percutaneous sclerotherapy using polidocanol in the treatment of aneurysmal bone cysts of extremities – a report of 28 consecutive cases

Introduction and aim. Aneurysmal bone cysts (ABC) are aggressive benign lesions with high rates of recurrence rendering its treatment uniquely challenging. We report the outcome in 28 consecutive patients of ABC of extremities treated with percutaneus sclerotherapy using 3% polidocanol over a period of 5 years. Material and methods. In biopsy proven 28 ABC cases, Injection polidocanol 3% was used as sclerosing agent under fluoroscopy guidance. Injections were repeated at 6-week intervals till complete healing of cysts. Radiological and functional results were assessed by Rastogi et al. criteria, VAS score and Enneking scoring method. Results. 25 out of 26 patients (89.28%) displayed good clinical response with an average 2.56 injections per patients. The mean follow-up period was 17.04±7.08 months. Reduction in cyst volume (mean 6.86±1.48 to 0.71±1.48.) and VAS score (mean 6.72±1.51 to 0.56±1.08) and improvement in Enneking score (17.35±3.14 to 28.92±1.35) at last follow up was significant. No recurrence was reported during the study period. Treatment failure, skin sclerosis and infection were reported in one case each. Conclusion. sclerotherapy with polidocanol 3% for primary ABC is safe and effective alternate method with advantage of no surgical morbidity, having better functional score with lesser recurrence and minimal complications.

Biliary Ablation for Sectoral Duct Injury to Avoid Surgery

AbstractBile duct injury is a common and serious complication of both laparoscopic and open cholecystectomy. The conventional treatment for isolated bile duct injury is hepaticojejunostomy or hepatectomy. We present a case of biliary leak from an isolated right posterior sectoral duct after cholecystectomy treated with percutaneous sclerotherapy using alcohol. Approval and consent waiver were obtained from the Institutional Review Board (IRB 2023-CR-18).

Treatment of Postoperative Neck Dissection Cervical Lymphocele With Percutaneous Bleomycin Sclerotherapy.

Lymphatic leak after lymph node dissection is a rare but well-known surgical complication that is often treated with conservative management and ultimately reoperation. The purpose of this report is to offer an alternative treatment for chyle leak that avoids hospitalization and subsequent surgery. Sclerotherapy has been used to treat lymphatic leaks in the past and has been shown to be safe and effective. This report presents a patient with a known cervical lymphocele who was followed through multiple sclerotherapy appointments until resolution of the lymphocele.

Percutaneous Sclerotherapy as Therapeutic Option in Benign Vascular Lesions: A Retrospective Study

Introduction:Sclerotherapy, a minimally invasive approach, has gained prominence as a therapeutic modality for the treatment of these lesions. The objective of this article is to assess clinical success, complications and periprocedural pain score of sclerotherapy and their variation with the nature of the lesion and choice of sclerosants. Methods: This was a hospital record-based retrospective study in a tertiary care centre in Kathmandu. Sclerotherapy done in the institute from January 2019 to December 2022 was evaluated for the nature of the lesion, clinical success, number of sessions, periprocedural pain score and complications. All sclerotherapy was performed under combined USG and fluoroscopic guidance by an interventional radiologist. Data was entered in predesigned proforma and data analysis was done using SPSS 25.0. Results: A total of 33 patients underwent 61 sessions of sclerotherapy during the study period. Venous malformation (72.2%) was the most common vascular lesion followed by hemangioma. There was significant resolution of symptoms post sclerotherapy pain relief in 95% complete resolution of swelling in 65.38 % and partial resolution with acceptable cosmetic results in 26.92% of cases. Only minor complications were seen in 6.5% of cases. The median periprocedural pain score was 5 with an interquartile range of 2. Periprocedural pain was significantly less with sodium tetradecyl sulphate than with alcohol(P-0.002). The resolution of swelling was less in hemangiomas than in other lesions, while pain relief was similar for all lesions. Complications were seen only in the alcohol group. Conclusions: Sclerotherapy is a safe and effective procedure for benign vascular lesions. Complications and periprocedural pain are less with sodium tetradecyl sulphate as compared to alcohol.

Lymphocele Complication After Kidney Transplant: Current Literature Review and Management Algorithm.

Kidney transplant is the best treatment option for patients with end-stage renal disease. It reduces mortality and improves the quality of life. However, kidney transplant presents medical and surgical complications, and one of the most common is the posttransplant lymphocele. Lymphocele complication has an incidence of up to 20% and presents with variable clinical symptoms, which are directly associated with the size and compression effect on the adjacent organs. There are reported risk factors that favor the appearance of lymphocele. Despite known factors, there are more relevant factors (male sex, deceased donor, and corticosteroids) to carry out a stricter follow-up. The treatment of lymphoceles can vary according to the severity of the symptoms, characteristics of the collection, and the patient's clinical status. Despite the high recurrence, percutaneous intervention is the initial approach in this condition. If percutaneous aspiration, drainage, and sclerotherapy are unsuccessful, then open or laparoscopic fenestration can be performed; laparoscopy is the standard of treatment since it is highly effective and has few adverse effects.