Sclerotherapy Technique Research Articles

Challenging cases of adherent periarterial vein during subinguinal Fisch technique and subinguinal micro-varicocelecotmy and sclerotherapy: a prospective comparative study

BackgroundTo the best of our knowledge, there is a gap in the review of literature about the most suitable varicocelectomy technique in isolating and ligating adherent periarterial vein(s). Consequently, leaving the artery intact or ligating it together with the adherent vein may pose a challenge. We conducted a comparative prospective study to assess the outcomes of the three techniques namely Fisch, sclerotherapy and microvaricoclectomy (MSV).ResultsThe patients who underwent MSV showed the longest operative time (66.29 ± 2.78 min), followed by Fisch technique (56.94 ± 3.07 min) then sclerotherapy (55.45 ± 1.99). Thus, the difference in the operative time between the three techniques was statistically significant (P < 0.001). Regarding the postoperative right vein diameter, MSV group showed the largest diameter (2.14 ± 0.15 mm), followed by Fisch technique (2.13 ± 0.15 mm) then sclerotherapy (1.75 ± 0.42 mm). Regarding the postoperative left vein diameter, MSV group showed again the largest diameter (2.17 ± 0.21 mm), followed by Fisch technique (2.14 ± 0.15 mm) then sclerotherapy (1.75 ± 0.42 mm). Moreover, the patients who underwent sclerotherapy showed the highest postoperative progressive sperm motility percent (25.27 ± 4.00%), followed by Fisch technique (21.56 ± 7.30%) then MSV group (19.85 ± 6.33%). Post hoc pair wise comparisons revealed that sclerotherapy and Fisch technique had a significantly higher effectiveness in reducing operative time than MSV. Additionally, it revealed that sclerotherapy technique had a significantly higher effectiveness in reducing postoperative vein diameters measurement than MSV and Fisch technique. Post hoc pair wise comparisons revealed that sclerotherapy technique had a significantly higher effectiveness in improving the postoperative progressive sperm motility percent than MSV.Patients who underwent the 3 techniques demonstrated statistically significant differences between baseline and post-operative vein diameter, reflux duration, sperm concentration, progressive sperm motility, progressive motile count/ejaculate and sperm abnormal forms.ConclusionThe 3 techniques showed significant improvement in the semen parameters after 3 months in the studied patients. However, sclerotherapy technique showed a significantly higher effectiveness in improving the postoperative progressive sperm motility percent compared to MSV.

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 &lt;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.

Successful Ultrasound Guided Sclerotherapy Technique for the Management of a Microcystic Warthin’s Tumor

Abstract Ultrasonographic descriptions of Warthin’s tumor (WT) vary from a predominately macrocystic appearance (anechoic with internal septations) to microcystic (multiple, diffuse, 1–2 mm anechoic areas). While the current first-line treatment for WTs is surgical excision, ultrasound-guided ethanol sclerotherapy (UGES) demonstrates success in macrocystic WTs, with aspiration of the cystic contents followed by injection of the sclerosing agent. Typically, microcystic tumors are thought to be unresponsive to sclerotherapy. In this case, we report the first application of ethanol sclerotherapy without ultrasound-guided aspiration for the treatment of a microcystic WT. The patient presented with a 2.0 cm × 1.97 cm × 3.05 cm right parotid mass of 9 years’ duration. UGES was performed in clinic under local anesthesia through injection of 97% ethanol in the three separate components of the target lesion. Six months postprocedure, ultrasound evaluation demonstrated a volume reduction rate of 78.53%. The patient reported significant cosmetic improvement and no observed complications.

Sub-ulcer Foam Sclerotherapy in Patients with Venous Leg Ulcer, Analysis and Technical Aspects of 134 Consecutive Patients.

For this retrospective study, we analyzed the sub-ulcer foam sclerotherapy technique in patients with venous leg ulcer (VLU). This study included 134 patients treated with sub-ulcer foam sclerotherapy at the Oulu University Hospital vascular outpatient clinic from January 2012 to December 2021. All included patients received sub-ulcer foam sclerotherapy as part of the treatment strategy for superficial venous insufficiency. Compression therapy and local wound care were organized for VLU treatment. A follow-up visit was scheduled for one month after the sub-ulcer foam sclerotherapy. Change in ulcer size, local (skin necrosis, infection) or systemic (deep vein thrombosis, pulmonary embolism) complications, and time to ulcer healing were monitored. The occurrence of major limb-related complications (amputation, surgical revision) was monitored for one year postoperatively. One month after sub-ulcer treatment, ulcers were smaller or completely healed in 108 (81%) patients. Ulcer healing was completed in 123 (92%) patients at one year and 131 (98%) patients at two years. Complications were recorded in four (3%) patients, three (2%) who were diagnosed with erysipelas requiring antibiotic treatment and one (1%) patient diagnosed with local dermatitis. During the one-year follow-up, no major limb-related complications (surgical revisions or amputations) arose. Sub-ulcer foam sclerotherapy may be a feasible addition to superficial vein reflux elimination in patients with VLU and a low risk for complications.

Ethanol Sclerotherapy in the Management of Ovarian Endometrioma: Technical Considerations for Catheter- and Needle-Directed Sclerotherapy

PurposeTo provide technical guidance on applying catheter-directed and needle-directed ethanol sclerotherapy for endometriomas and present the results of these sclerotherapy methods.Materials and MethodsFrom January 2015 to March 2021, the results of the patients with symptomatic ovarian endometriomas who underwent needle-directed or catheter-directed sclerotherapy were evaluated, retrospectively. The decision to apply which sclerotherapy technique was made during the procedure for each patient considering the following factors: cyst size, cyst location, cyst viscosity, and tissue rigidity.ResultsBoth needle-directed (n = 34 cysts) and catheter-directed (n = 34 cysts) sclerotherapy techniques were effective, with a 100% technical success rate and a 97% clinical success rate. In two of 34 cysts (6%) treated with needle-directed sclerotherapy, recurrence was detected and successfully retreated with catheter-directed sclerotherapy. Significant reductions in cyst size, pain, and serum cancer antigen 125 levels (p < 0.05) were noted. Serum anti-Müllerian hormone levels remained unaffected, indicating preserved ovarian reserve (p > 0.05). Among those treated for infertility, the pregnancy rate was 54% (n = 6/11). The mean ± SD cyst size decline was greater in catheter-directed sclerotherapy than needle-directed sclerotherapy (5.5 ± 3.1 cm vs. 4.0 ± 2.1 cm, p < 0.05). However, the pretreatment cyst volumes were considerably higher in catheter-directed sclerotherapy group (202.0 ± 233.5 mL vs. 78.8 ± 59.7 mL, p < 0.05) and were associated with significant post-treatment volume decrease (p < 0.05).ConclusionThe choice between catheter-directed and needle-directed ethanol sclerotherapy should be determined during the procedure, with a preference for catheter-directed sclerotherapy when feasible. Crucial factors in making this decision include cyst size, cyst location, cyst viscosity, and tissue rigidity.Level of evidence Level 3, non-controlled retrospective cohort study.Graphical

Experience of the combined application of sclerotherapy and endovascular embolization in the treatment of venous and arteriovenous malformations of surface location

Objective ‒ to evaluate the results of treatment of patients with extra-trunk (diffuse) venous malformations (VM) and microfistulous arteriovenous malformations (AVM) of superficial localization, to whom the technique of sclerotherapy was applied, by direct puncture of the «node» of the malformation and a combination of endovascular embolization with sclerotherapy. Determine the criteria for using the sclerosation method as monotherapy or in combination with embolization.Materials and methods. In the period from 2017 to 2023, 47 patients (22 (46.8 %) men and 25 (53.2 %) women) with VM (n=27) and AVM (n=20) located superficially were examined and treated were treated for the malformation using sclerosation. The age of the patients ranged from 5 to 67 years, the average age ‒ (28.9 ± 7.4) years. Pathology localization: head and neck – 31, upper extremity – 6, lower extremity – 7, trunk – 3. In 17 patients, sclerotherapy was used as monotherapy, 30 patients underwent a combination of sclerotherapy with embolization The observation period ranged from 6 months to 8 years, the average observation period was (5.2 ± 0.98) years.Results. Out of 27 patients with VM, 17 (62.9 %) patients were diagnosed with a VM based on the results of diagnostic venography and arteriography. From 17 patients were treated with sclerotherapy as monotherapy with a satisfactory clinical result in 14 (82.3 %) patients. In 10 (37.1 %) 27 patients with VM, signs of arteriovenous shunt (AVS) were found in the structure of VM. A combination of endovascular embolization and sclerosation was used in the treatment of VM with signs of arteriovenous shunting in 10 patients. A positive effect was obtained in 7 (70.0 %) cases. AVM treatment using a combination of sclerosation and embolization was carried out in 20 patients. A satisfactory clinical result was obtained in 17 (85.0 %) patients. Treatment of 47 patients with VM and AVM was technically successful in all cases (100 %). Overall clinical improvement was obtained in 38 (81.0 %). A complication in the form of tissue necrosis in the malformation area occurred in 3 (6.4 %) patients. 43 (91.4 %) patients received 2 to 4 AVM embolization and 2 to 5 sclerotherapy sessions during the treatment period.Conclusions. According to the obtained results, sclerotherapy by direct puncture of the venous structures of malformations with the introduction of a sclerosing drug into the «node» is a safe and effective method of treating VM. In every third patient (37.1 %) with VM, signs of AVS were found in the structure of VM, which requires prior embolization of existing AVS. Preliminary embolization of the afferent arteries of AVM leads to a slowing down of the blood flow rate and enables the use of sclerotherapy techniques, maintaining the effective concentration of the drug in the «node» of the AVM. Evaluation of the results of the treatment of 47 patients with extra-trunk (diffuse) venous and microfistulous AVM of superficial localization using the methods of endovascular embolization and sclerotherapy proves that the combined use of these methods allows to improve the results and increase the effectiveness of the treatment of this complex pathology.

A technical review of percutaneous sclerotherapy with bleomycin for giant hepatic venous malformation

BackgroundHepatic venous malformation (HVM), traditionally called liver haemangioma, is considered the most common benign hepatic lesion. Treatment might be indicated in large and symptomatic HVMs. We aim to describe stepwise technical aspects of trans-hepatic percutaneous sclerotherapy of hepatic venous malformation (HVM).Main textPatients with symptomatic HVM larger than 5 cm are selected after discussion in hepatobiliary multidisciplinary team. After prophylactic antibiotic and corticosteroid administration, local anaesthesia and conscious sedation are applied. A 22-gauge spinal or Chiba needle is used to obtain percutaneous access to the HVM through normal liver parenchyma under ultrasound guidance. To ensure proper needle placement and to prevent accidental delivery of sclerosant into unintended areas, about 5–10 mL iodine contrast is injected under fluoroscopy. Then, 45–60 IU bleomycin is mixed with 10 mL distilled water and 10 mL lipiodol and is slowly injected under fluoroscopy over a period of 20–30 s. After the needle is removed, manual pressure is applied over the puncture site for a period of 5 min followed by placement of a sandbag. Patients are monitored for 6–8 h post-procedure.ConclusionIn this technical review, we described our institutional technique of percutaneous sclerotherapy, which could be regarded as an alternative to TAE in the management of HVM.

The place of sclerotherapy in the treatment of varicose vein disease

Aim. To evaluate effectiveness of the scleroobliteration in the treatment of small-diameter varicose veins.Materials and Methods. The analysis incorporated the results of sclerotherapy in 135 patients, comprising those with telangiectasias and reticular varicose veins (n=95) and those with varicose dilation of aberrant subcutaneous veins (n=40) with intact trunks of major and/or minor subcutaneous veins of the lower extremities. The sample included 111 women (82.2%) and 24 men (17.8%), with an average age of 35.2±6.5 years.For the obliteration of expanded subcutaneous veins, two sclerotherapy techniques were employed: liquid (n=65) and foam-form (n=70), prepared as per the L. Tessari method. Sclerosants used were a 0.5–3% sodium tetradecyl sulfate solution (“Fibro vein”) (ATC code: C05BB04) (n=69) or a 1-3% polidocanol solution (“Ethoxisclerol”) (ATC code: C05BB02) (n=66).A detailed analysis was carried out of all complications that developed during and at various times post-sclerotherapy, and the effectiveness of the treatment, which depended on the diameter of the expanded veins and the thoroughness of the procedure.Results. The technical success of the procedure was registered at 100%. The overall frequency of complications post-sclerotherapy was 20.7%, including 27.7% with the liquid form and 14.3% with the foam form of sclerosants (p&lt;0.001). Intradermal and subcutaneous hemorrhages were observed in 10 (7.4%) patients, allergic reactions in 8 (5.9%), localized skin necrosis in 3 (2.2%), folliculitis in 3 (2.2%), and localized purulent complications in 2 (1.5%). Micro-air embolism of the pulmonary artery branches due to exceeding the established norm of air volume during foam sclerotherapy was recorded in 2 (2.9%) cases.Following one session, a positive sclerotherapy effect was noted in 45.9% of patients. The necessity for additional sclerotherapy courses was indicated for over half the patients, with the effectiveness rising to 97.8% after 3 or more courses.Conclusion. Sclerotherapy, being an effective minimally invasive method, is significantly impactful in treating reticular varices and telangiectasias. Greater efficiency and a lower rate of complications have been observed with the use of foam form sclerosant. Proper selection of sclerosant volume and concentration is essential for the prevention and reduction of sclerotherapy complications.

Hyperpigmentation after sclerotherapy: modern possibilities for prevention and treatment

Sclerotherapy is one of the most popular and most common techniques for the removal of delated reticular veins and telangiectasias on the lower limbs. Despite the vast pooled experience, this procedure can be accompanied by a number of undesirable side effects, of which post-injection hyperpigmentation, which frequency reaches 80%, is the most unpleasant one. The development of postsclerotherapy hyperpigmentation (PSHP) is associated with extravasation and destruction of red blood cells, which results in transformation of haemoglobin into hemosiderin pigment. PSHP is, by definition, a variant of post-traumatic hemosiderin pigmentation. The likelihood of occurrence and persistence of PSHP is determined by a number of hard controllable factors, including the calibre and location of the target veins, the type, concentration and physical form of the sclerosing agent, the sclerotherapy technique, the method and duration of post-procedural compression, patients’ ethnicity, iron metabolism disorders, concomitant use of a number of drugs, a menstrual cycle phase in women, etc. Hyperpigmentation significantly decreases the patients’ quality of life, which determines the need for the prevention and treatment of this undesirable side effect of phlebosclerosing treatment. Recommendations for prevention of PSHP include a detailed history taking aimed at identifying potential risk factors, in the presence of which it is advisable to use various systemic and topical drugs in the post-procedural period in order to prevent the skin hemosiderin deposition, as well as to apply the extended-cycle compression. In the case of PSHP, procedures aimed at the destruction and utilization of hemosiderin, such as Q-Switched laser and IPL therapy, as well as various peeling options intended to speed up the replacement of pigmented skin with normal, can be applied. For the PSHP prevention and treatment, the use of Contractubex containing cepalin onion extract in combination with allantoin and heparin is a matter of interest. Contractubex is a drug originally intended to optimize wound healing and prevent the formation of hypertrophic scars. At the same time, there is ample publications discussing the possible use of this drug for the management of post-traumatic hyperpigmentation due to the combined action of its components. Our clinical experience confirms the effectiveness of Contractubex in the treatment of PSHP, which determines the feasibility of conducting full-fledged clinical trials and accumulating more pooled experience in this area.

Investigating the efficacy of ultrasound-guided ethanol retention technique for endometrioma sclerotherapy and its effect on pro-inflammatory cytokine levels: A single-arm clinical trial

BackgroundEndometriosis is a chronic inflammatory disease affecting about 10% of women of reproductive age. Endometrioma is the most common presentation of endometriosis in ovaries. ObjectivesHerein, the authors study the effect of the ultrasound-guided ethanol retention technique for endometrioma sclerotherapy and its effect on the plasma levels of pro-inflammatory cytokines. Materials and methodsEach endometrioma was aspirated and washed with 0.9% saline until clearance and then 2/3 of the cyst volume was filled with ethanol 98%. Patients were followed for 3 months. After that, changes in their cyst diameter, dyspareunia, dysmenorrhea, and antral follicular count were assessed. Also, the sera levels of Interleukin 1β (IL-β), IL-6, and IL-8 were assayed before and after the treatment. The primary sera levels were also compared with a control group. ResultsIn the treatment and control groups, 23 and 25 individuals (respectively) with a matched mean age (p-value = 0.680) were enrolled in the study. Among the laboratory variables, IL-1β (p-value = 0.035), as well as AMH (p-value = 0.002), were lower, and IL-6 (p-value = 0.011) was higher in the endometriosis group compared to the controls. Following the treatment, dysmenorrhea, dyspareunia, and the mean diameter of all cysts were significantly (p-values < 0.001) decreased in the treatment group. Also, right (p-value = 0.022) and left (p-value = 0.002) ovaries' antral follicular counts were increased following the treatment. No significant change was found among any of the investigated laboratory levels (p-value > 0.05). ConclusionEthanol retention method is proven to be safe and could improve the clinical status of patients with endometrioma. Although further studies are necessary.

Skull base chondroblastoma with aneurysmal bone cyst-like changes treated with percutaneous radiofrequency ablation and doxycycline sclerotherapy: illustrative case.

Chondroblastomas (CBs) are rare benign bone tumors that are often difficult to treat because of their locations. CBs can be even more challenging to successfully manage when they present alongside aneurysmal bone cyst (ABC)-like changes. To minimize operative morbidity, especially in hard-to-reach lesions, percutaneous approaches for both lesions have been individually described. We present a skull base CB with associated ABC-like changes treated by combining two different previously described percutaneous modalities. The authors report successful percutaneous treatment of a skull base CB with adjacent ABC-like changes in a 17-year-old male. The CB was treated with radiofrequency ablation (RFA) and the adjacent ABC area with doxycycline sclerotherapy. After 3 years of follow-up, there has been no clinical or radiological evidence of recurrence. CBs occur in the skull base and, as elsewhere in the body, can be associated with ABC-like changes. Successful percutaneous treatment of such a CB with ABC-like changes is possible by combining previously described techniques of RFA and doxycycline sclerotherapy.

Curettage and sclerotherapy technique: A hybrid approach to superficial lymphatic malformation.

To describe the curettage and sclerotherapy technique, a hybrid approach to treatment for superficial lymphatic malformations. A retrospective analysis of a lymphatic malformation data base was performed. Patients with superficial lymphatic malformation treated by curettage and sclerotherapy technique with bleomycin were included in this study. Safety and efficacy of the curettage and sclerotherapy technique with bleomycin were evaluated. Between September 2019 and October 2021, 10 consecutive patients (male/female ratio: 4:6; mean age, 10.9 years; range, 3-35 years) presented with superficial lymphatic malformations that were subsequently treated by curettage and sclerotherapy technique with bleomycin. All lesions were located on the trunk and extremities. Each patient received one treatment session and a mean follow-up of 12 months. We observed minor complications. No postoperative infections occurred in this series. No patient developed skin ulceration or necrosis. Scarring and recurrence occurred in one patient. Complete regression was confirmed for all 10 patients by photographic evaluation. A curettage and sclerotherapy technique is proposed to treat superficial lymphatic malformation in this study. This technique seems to be safe and highly effective.

Combination technique of polidocanol sclerotherapy and radiofrequency ablation in venous malformations of lip.

The authors declare no potential conflict of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

SCLEROTHERAPY OF VASCULAR LESIONS IN ORAL AND MAXILLOFACIAL REGION—CASE SERIES

Sclerosing therapy of vascular lesions is widely used in the maxillofacial region, resulting in good esthetic and functional outcomes. Ethamolin, a sclerosing agent, can be applied pure or diluted in distilled water. When this therapeutic method is performed, signs and symptoms such as edema, erythema, and pain in the postoperative period can be observed. Five cases treated with monoethanolamine oleate diluted in anesthetic solution of lidocaine (1:1) will be described, including 4 male patients and 1 female patient (2 in the lower lip, 1 in the upper lip mucosa, 1 in the buccal mucosa, and 1 in the tongue). One of the patients used oral anticoagulants and had an extensive lesion on the tongue (approximately 3.5 cm). All patients reported minimal discomfort during intralesional injection. The sclerotherapy technique described above is a conservative therapeutic approach that reduced patient morbidity and postsurgical complications (scarring, hemorrhages, and paresthesia). Furthermore, it seems to reduce painful symptoms.

Liposuction-Like Sclerotherapy Technique for Microcystic Lymphatic Malformation

BackgroundThe treatment for microcystic lymphatic malformation (LM) remains challenging. We describe the liposuction-like sclerotherapy technique, a new treatment for extensive microcystic LM.MethodsLM data was retrospectively reviewed. This study included patients with a microcystic LM component treated by liposuction-like technique with bleomycin sclerotherapy.ResultsBetween June 2016 and October 2019, 39 consecutive patients (male/female ratio: 21:18; mean age, 33.6 months; range: 5 months to 15 years) with microcystic LM were treated by liposuction-like sclerotherapy (LS-LS) technique. Fifty-six sessions of LS-LS were performed (mean of 1.44 sessions per patient; range: one to four sessions). Follow-up ranged 6-30 months (mean of 21 months). We observed no major complications. Transient minor complications included: postoperative noninfectious fever, vomiting, temporary skin edema, pigmentation, mild local depressions, and/or irregularities, and a small hyperpigmented scar at the incision. No postoperative infection, skin ulcer, or necrosis occurred. The patients’ symptoms were successfully resolved or stable. A sub-complete response and partial response were observed for 26 (76%) and 13 patients (33%), respectively.ConclusionThe LS-LS technique for microcystic LMs is safe, feasible, and effective. This technique is an effective intervention with which it is possible to manage and potentially cure microcystic LM clinically.

USE OF HYPERTONIC GLUCOSE AS A SCLEROSANT IN THE TREATMENT OF MICROVASES

Telangiectasias and microvessels are the most common types of varicose veins, usually their appearance is related to genetic susceptibility, normally affecting the lower limbs of the body. The PEIM (Aesthetic Injectable Procedure in Microvessels) has been widely used to eliminate telangiectasias and microvessels. Therefore, the objective was to describe the effectiveness of liquid sclerosing agents in the treatment of telangiectasias and microvessels. This work is part of a literary review covering the period between 1986 and 2020 using Scielo, Google Scholar and Pubmed platforms. Telangiectasias and microvessels generally do not present health problems, most of the time the problem is esthetic without pathological character. Currently, there are several sclerosing substances used in the treatment, in this case, hypertonic glucose is identified as one of the most used sclerosing agents, because, even though a treatment takes a little longer to obtain results, it is a little painful, the risk of complications is lower and procedure value is affordable. Although the sclerotherapy technique has been used for a long time, so far no sclerosant with absence and complications and totally effective has been discovered, even though there are case studies that report to the contrary, thus, this literature review shows that more studies are needed. to prove the efficacy and safety of hypertonic glucose.

Microfoam sclerotherapy of superficial venous malformations of the upper limbs

Venous malformations are the most common type of angiodysplasia, which cause both physiological and emotional discomfort to patients. Arteriovenous malformations occur most often in the upper and lower limbs at the ratio of 20.9% and 46.4%, respectively. On top of that, 70% of cases of superficial arteriovenous malformations are found in women. In this article, the authors present a clinical example of the effectiveness of microfoam sclerotherapy and show a long-term outcome in a patient with superficial venous malformations of her hands, which are accompanied with such symptoms as as pain and bleeding. As a sclerosing agent, a 1–3% sodium tetradecyl sulphate solution was used, followed by compression using class 2 garments (RAL standard) such as an arm sleeve and gloves. The interval between procedures was 4 to 6 weeks. After several sessions, the superficial venous malformations of the upper limb decreased in the size and volume, and the patient presented less complaints. A 5-year follow-up showed no growth of malformations and re-bleeding complications. Microfoam sclerotherapy of superficial venous malformations in the upper limbs (hands) has good long-term outcomes and allows patients to avoid traumatic surgery. Given this comparability of the surgical and minimally invasive techniques, the use of the latter option, in particular, the foam sclerotherapy technique, makes economic and financial sense.

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.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ЛИМФАТИЧЕСКИХ МАЛЬФОРМАЦИЙ ОБЛАСТИ ГОЛОВЫ И ШЕИ У ДЕТЕЙ

The variety of forms and localizations of lymphatic malformations (LMs) in the head and neck region determine the lack of unified approach to the treatment of this pathology. The surgical approach is divided into minimally invasive sclerotherapy technique, used mainly for macrocystic forms of LM, and classical surgery, which includes a wide range of surgical interventions on organs and structures of the head and neck. A combination of these two methods and planning of surgical staging are the key to success in the treatment of mixed forms of LMs and malformations of complex localizations with extensive distribution.

Bleomycin for Percutaneous Sclerotherapy of Venous and Lymphatic Malformations: A Retrospective Study of Safety, Efficacy and Mid-Term Outcomes in 26 Patients.

Percutaneous sclerotherapy is used to treat venous and lymphatic vascular malformations, which can cause significant discomfort and/or disfigurement. The purpose of this study is to describe the bleomycin sclerotherapy technique and to evaluate its clinical and radiological efficacy and safety. We retrospectively identified consecutive patients with venous malformations (VMs) and lymphatic malformations (LMs) who underwent bleomycin sclerotherapy in 2011–2020 at our institution. We collected the clinical and radiological success rates, complications and recurrences separately in the VM and LM groups. We identified 26 patients, 15 with VMs and 11 with LMs. The significant volume reductions obtained were 45% in the VM group and 76% in the LM group (p = 0.003 and p = 0.009, respectively). Significant reductions in discomfort/pain and in cosmetic disfigurement were obtained in both groups. An overall improvement was reported by 69% and 82% of patients in the VM and LM groups, respectively. No major complications occurred during the mean follow-up of 51 ± 34 months in the VM group and 29 ± 18 months in the LM group. A recurrence developed within 2 years in 23% of patients. Bleomycin is clinically and radiologically effective for the treatment of venous and lymphatic malformations, with a high level of patient safety.