Sodium Tetradecyl Research Articles

Percutaneous Drainage and Ablation as First Line Therapy for Macrocystic and Microcystic Orbital Lymphatic Malformations

To review the management of orbital lymphangiomas and to propose a new treatment for both macrocystic and microcystic lymphatic malformations of the orbit. A retrospective case series of all patients from the authors' practice from 2001 to the present who met the histopathologic and/or diagnostic imaging criteria for orbital lymphatic malformation was reviewed. Lymphatic malformation was diagnosed if there was a multilobulated pattern on CT or a cystic internal structure on ultrasonography. In patients that were treated, macrocysts (>1 cm) were treated with dual-drug chemoablation (sequential intracystic sodium tetradecyl sulfate and ethanol); doxycycline injections were used for microcysts. The goal of treatment was complete cyst ablation documented by ultrasonography or MRI. Twenty patients met the inclusion criteria. They were separated in 3 groups based on the anatomical location of the lymphatic malformation: deep, superficial, or combined. Deep orbital lymphatic malformation presented in 14 patients (70%), superficial presented in 4 patients (20%), and both deep and superficial presented in 2 patients (10%). Thirteen of the 20 patients underwent percutaneous sclerotherapy. Of those treated, 7 patients (53.8%) had lymphatic malformations (LM), while 6 patients (46.2%) had venous-lymphatic malformations (VLMs). The average number of treatments required to achieve complete cyst ablation in patients with LM was 1.7. The average number of treatments required for patients with VLM was 3.0; however, some of these patients continue to have the venous component of their lesions treated. Clinically, all treated patients maintained or improved an average of one Snellen line (-0.16 decimal Snellen equivalent) from their preoperative visual acuity to their last recorded follow-up visit. There was a mean reduction in proptosis of 2.4 mm (p - 0.003, confidence interval [CI] 0.838 to 3.962), which was statistically significant. There were no recurrences (0%) in patients who completed treatment with cyst ablation (n - 8) at an average follow-up period of 43 months (range 6-96, standard deviation 30). There were no data available as to the recurrence status of one patient. Four patients were still undergoing treatment for a venous component at the time of this review. Percutaneous sclerotherapy provides a safe and effective treatment for both macrocystic and microcystic orbital lymphatic malformations as a primary treatment or for recurrence after surgical intervention.

Sodium tetradecyl sulphate sclerotherapy for treating venous malformations of the oral and pharyngeal regions in children

ObjectiveVenous vascular malformations in the head and neck region present a difficult management challenge. We describe our experience of using sodium tetradecyl sulphate injection sclerotherapy to treat children presenting with venous malformations of the oral and pharyngeal region. MethodsWe performed a retrospective case note review of consecutive children treated at our institution between 2004 and 2011. Patient notes were analysed for demographic details, site and size of lesion, number and duration of treatments, treatment response and complications. ResultsTwelve patients were included (7 boys and 5 girls, mean age 7 years). Sites of lesions included tongue, floor of mouth, pharynx, tonsillar fossae, parapharyngeal space and soft palate. All patients were treated with 3% sodium tetradecyl sulphate (STS) foam injected trans-orally or percutaneously under ultrasound or fluoroscopic guidance. The lesions had a mean volume of 4ml (range 2–14ml). An average of 3 treatments was required (range 1–9). In 4 patients a single treatment was sufficient. For those patients requiring multiple treatments, a mean of 4 treatments were required over an average period of 28 months. The overall response rate was 83% (10/12). Complete resolution was achieved in 4 cases (33%) with a significant reduction in size in a further 6 cases (50%). Larger lesions generally require more treatments than low volume lesions. Two cases recurred despite treatment. One patient suffered minor bleeding following transcutaneous injection. ConclusionsInjection sclerotherapy using STS foam offers an effective treatment option when managing children presenting with venous malformations in the oral and pharyngeal. A single treatment may be adequate for small lesions but the procedure may be safely repeated until a satisfactory result is obtained.

Role of injection pressure, flow and sclerosant viscosity in causing cutaneous ulceration during sclerotherapy

The objective of the study is to evaluate the viscosity of popular sclerosants and their flow hydrodynamics through a syringe/needle to further discuss Miyake's old, venous-capillary reflux theory, using additional objective data. The following sclerosing agents were tested in the study: 75% dextrose (D75%); 50% dextrose (D50%); 5% ethanolamine oleate (Etha5%); 0.5% laureth-9 (Aet0.5%) and 0.1% sodium tetradecyl sulphate (STS0.1%). Using 5 mL syringes and 27G needles, the resulting pressures and flows for each sclerosant agent were measured. To do this, a three-way stopcock was connected between the syringe and the needle so that an arm of the stopcock could be used to measure injection pressures with a digital monitor in 1 mmHg increments. Two trials were performed: in trial 1, the syringe was attached to a Samtronic 680 infusion pump and in trial 2, the solutions were injected manually. The observed sclerosant viscosities were as follows: D75%: 0.28 Poise; D50%: 0.12 Poise; Etha5%: 0.10 Poise; Aet0.5%: 0.07 Poise; and STS0.1%: 0.04 Poise. In trial 1 (constant flow), it was observed that D75%, which had the highest viscosity of the sclerosants tested, had the highest pressure readings. In trial 2 (constant pressure), the flow obtained with the D75% solution was lower than the flow of the other solutions. In conclusion, based on the rabbit study theory, vessel size and sclerosant viscosity and strength, not extravasation, play a role in causing ulceration from injection sclerotherapy. As a result, they all affect the potential of venous-capillary reflux being caused by sclerotherapy injection and, thus, the risk of postsclerotherapeutic cutaneous ulceration.

Intralesional bleomycin and sodium tetradecyl sulphate for haemangiomas and lymphangiomas

To compare the efficacy of intralesional bleomycin and sodium tetradecyl sulphate in treatment of haemangiomas and lymphangiomas. Between July 2007 and May 2009, 120 patients, sixty each of peripheral haemangiomas and lymphangiomas, were administered intralesional injection of bleomycin in a dose of 0.5-1 U/kg in children less than one year of age and 1 to 15 units in children more than one year of age and 1 to 3 ml of 2% sodium tetradecyl sulphate, depending on the size of the lesion at intervals of 14 days. Patients more than 20 years of age and those with diffuse or visceral lesions were excluded from the study. Complete resolution occurred in 16 patients (53%) of haemangiomas and 14 patients (47%) of lymphangiomas treated with bleomycin, while the results were 12 patients (40%) and 10 patients (33%), respectively, in sodium tetradecyl sulphate group. The satisfactory resolution (resolution more than 50%) occurred in eight patients (27%) of haemangiomas and lymphangiomas groups treated with bleomycin, while the results were six patients (20%) and eight patients (27%), respectively, in sodium tetradecyl sulphate group. Poor response rate was observed in six patients (20%) of haemangiomas and eight patients (27%) of lymphangiomas of bleomycin group and 12 patients (40%) of haemangiomas and lymphangiomas in sodium tetradecyl sulphate group. No pulmonary fibrosis or other serious side effects were found. Intralesional bleomycin and sodium tetradecyl sulphate are effective sclerosants in peripheral haemangiomas and lymphangiomas, but bleomycin was found to be more efficacious.

Low flow vascular malformation of the buccal mucosa treated conservatively by sclerotherapy (3% sodium tetradecyl sulfate)

Vascular anomalies constitute some of the most difficult diagnostic and therapeutic enigmas in the head and neck region. It is of paramount importance that a modern classification system is established to differentiate vascular lesions from vascular malformations. Vascular malformations are usually congenital and venous anomalies usually expand because of hormonal changes such as puberty, pregnancy, or secondary to trauma. Here, we report a case which was diagnosed as low flow vascular malformation of buccal mucosa involving the lower lip and subsequently treated with 3% sodium tetra decyl sulfate. This paper provides overall understanding regarding the presentation and management of small vascular lesions in the orofacial region. Percutaneous sodium tetradecyl sulfate when used either alone or as adjunct to surgery is a safe, effective, and inexpensive agent in the treatment of venous malformations. However, proper case selection, evaluation, and careful planning are necessary to reduce the unwarranted risks and complications.

Efficacy of Submucosal Sodium Tetradecyl Sulfate in the Soft Palate as a Treatment of the Mild Obstructive Sleep Apnea Syndrome: A Pilot Study

Background. As described by Mair et al. in 2001, snoreplasty, the application of sclerosant agents in the palate is a promising and cheap alternative to treat snoring. We decided to try this kind of therapy for the management of mild sleep apnea. Study Design. Experimental, longitudinal, prospective, nonrandomized, self-controlled pilot study. Methods. 11 patients were included, all of them with a polysomnographic study showing an Apnea-Hypopnea Index (AHI) from 5 to 20, and with a Müller maneuver showing only retropalatal collapse. Results. We found significant decrease in the number of apneas hypopneas and oxygen desaturation as well as in the snoring index (P < 0.05), although no differences were found in the number of arousals. Conclusion. Sclerosant agents might become a relevant part in the treatment of sleep apnea, in very well-selected patients.

Comparative Analysis of Intralesional Sclerotherapy with Sodium Tetradecyl Sulfate Versus Bleomycin in the Management of Low Flow Craniofacial Soft Tissue Vascular Lesions

Comparison of the efficacy of bleomycin over sodium tetradecyl sulfate (STS) when given intralesionally in the treatment of oral and maxillofacial venous malformation. 16 patients with venous malformation in craniofacial region were randomly divided into two groups of eight. Group 1 was given intralesional injection of bleomycin and group 2 was injected with STS. All the cases were evaluated for a minimum period of two and a maximum of 3years. Efficacy of bleomycin was found to be superior to STS, when used as intralesional sclerotherapic agent. Most of the vascular lesions of group 1 resolved after first dose giving a cure rate of 87.5% and no recurrence was observed. Group 2 patients however, required 4-6, a mean of five repeated dosage of intralesional STS before their lesions started to resolve and three patients reported with recurrence within 2years, giving an overall effective response rate of 62.5%. Bleomycin under selected conditions appears to be an excellent therapy for treating soft tissue vascular lesions of low flow nature in craniofacial region. Predictable results were obtained with a high success rate. No systemic or pulmonary complications occurred.

Sclerotherapy for lower limb telangiectasias

Sclerotherapy has been used in clinical practice for centuries, but there is still no consensus about which, if any, sclerosing agent provides the best results. To assess the effectiveness and safety of sclerosing agents in the treatment of telangiectasias of the lower limbs. The Cochrane Peripheral Vascular Diseases (PVD) Group searched their Specialised Register (last searched 26 May 2011) and CENTRAL (2011, Issue 2). We searched references within identified studies and from the Cited References in the Web of Science. We contacted study authors and pharmaceutical companies. There were no language restrictions. We included randomised or quasi-randomised controlled trials on the treatment of telangiectasias comparing sclerotherapy with a normal saline placebo, no treatment or an alternative sclerotherapy regimen. Both authors determined which studies to include, extracted the data and rated risk of bias. One author (LS) contacted study authors and pharmaceutical companies and analysed the results. Ten studies involving 484 patients were included. There was no evidence suggesting superior efficacy of any one sclerosant over another, but there was evidence of superiority of sclerotherapy to placebo.The evidence did not suggest an increase in patient satisfaction with any one agent versus another, but there was evidence that patients were less satisfied with placebo.There was some evidence suggesting that polidocanol (POL) was more likely to cause adverse reactions at a concentration of 1% compared with lower concentrations or hypertonic saline, and that sodium tetradecyl sulfate (STS) was more likely to cause adverse reactions at a concentration of 1% compared with POL at 0.5%.There was some evidence suggesting that STS was more painful than POL, heparsal (20% saline mixed with heparin 100 units/mL) or placebo, and that POL was no more painful than placebo. Evidence from one study suggested that hypertonic saline (HS) was more painful than POL.The data were not suitable for meta-analysis. The evidence did not suggest superior efficacy or patient satisfaction for any one sclerosing agent used in the treatment of telangiectasias of the lower limbs, but the agents studied showed superiority to a normal saline placebo. However, the amount of available evidence in this field is small and the overall methodological quality of the research was poor, as was the quality of reporting. More research is needed to determine the optimal agent(s) and the ideal dosing to achieve the best results and maximize patient satisfaction. Future research efforts should incorporate more demographic data and symptom measures to allow for comparison with findings from observational studies, thereby aiding assessment of how various risk groups respond to treatment.

Percutaneous sclerotherapy in neonatal and infant head and neck lymphatic malformations: a single center experience

Purpose To evaluate the clinical outcomes of percutaneous sclerotherapy for congenital head and neck lymphatic malformations in our institution. Materials and Methods Over a 7-year period, 17 children (10 M, 7 F) mean age 5.8 months (5 days to 13 months) underwent 49 sclerotherapy procedures for congenital head and neck malformations. The imaging and clinical records were reviewed for each patient. Ten of 17 had macrocystic disease; 7 of 17 had microcystic disease. Imaging response was categorized by volume reductions of 0% to 25%, 25% to 50%, 50% to 75%, or 75% to 100%. A concentration of 10 mg/mL doxycycline was used routinely via catheter in 3 instillations with a dose range of 50 to 500 mg per session as per our standard protocol in 17 of 17 patients. In more recent patients, systemic doxycycline levels were obtained after instillations. Additional treatments included direct injection doxycycline (10/17), instillation of absolute ethanol (7/17) or sodium tetradecyl sulfate (4/17), or a combination of these methods. Results Imaging improvement of ≥76% was noted in 11 of 17. Of these, 8 of 11 had macrocystic disease. Four of 17 had 51% to 75% resolution, of which 3/4 were mixed. Two of 17 children had 25% to 50% resolution with a mixed lesion. Seven of 49 peri-procedural complications: hemolytic anemia in 2 infants, hypoglycemic and metabolic acidosis in 3 neonates aged 7 to 10 days, transient hypotension during absolute alcohol instillation in 1 neonate, and self-limiting skin excoriation secondary to peri-catheter leakage of doxycycline in one neonate. Neonates prone to these systemic complications had doxycycline doses of greater than 250 mg and resulted in serum levels of >5 μg/mL but as high as 21 μg/mL. Delayed neural complications occurred in 7 of 49 procedures, Horner's syndromes in 4 of 49 procedures, transient left lip weakness in 1 of 49 procedures, right facial nerve palsy in 1 of 49 procedures, and transient left hemidiaphragm paralysis in 1/49 procedures. Conclusion Our experience with catheter directed doxycycline sclerotherapy provides excellent results for large macrocystic head and neck lymphatic malformations. Microcystic and mixed lesions continue to provide a therapeutic challenge.

Synthesis of Nano-Emulsion with Allyl-Type Sodium Succinate Diester Emulsifier

In this study 50-70nm Nano-emulsion was synthesized by semi-continuous seeding emulsion with the compound of the different long-chain of carbon of the Allyl-type sodium Succinate Diester Emulsifier and traditional emulsifier. The type and amount of emulsifier, initiator and monomer ratio on the amount and impact of acrylic emulsion were discussed. The results showed that the obtained acrylic emulsion with the presence of polymerizable emulsion has significant lower water absorption and greater stability than that with the presence of traditional emulsifier. Measuring the solid content , particle size, stability, morphology, glass transition temperature and water absorption of the emulsion with the three types of allyl-type polymerizable emulsifier(sodium octyl allyl succinate (DOAS), sodium dodecyl succinate (SDAS) , tetradecyl sodium allyl succinate (TSAS)), considering various factors, sodium dodecyl allyl succinate has better emulsification.

Synthesis and Property of Polymerizable Sodium Sulfosuccinic Diester

Using different long-chain alcohols (octanol, dodecanol, tetradecyl alcohol), maleic anhydride, allyl chloride, sodium bisulfite as the main raw materials, a series of polymerizable emulsifier--allyl-type sodium sulfosuccinic diesters have been synthesized in this paper. Through single-esterification and double-esterification, three diesters have been synthesized. The sulfonation conditions are as follows: using sodium maleic acid monoester as the phase transfer catalyst, sodium bisulfite and double-ester were allowed to react in the ratio of 1.0: 1.1 at 110°C for 4h in the solvent of a mixture of ethanol and water. The yield of sulfonation on sodium octyl sulfosuccinic diester and sodium dodecyl sulfosuccinic diester as well as sodium tetradecyl sulfosuccinic diester were 94.8%(Ⅰ), 96.78%(Ⅱ) and 93.6%(Ⅲ), respectively. All products were charac 4 terized by IR spectra and 1H NMR, and their surface properties were tested. The results showed that the surface properties of dodecyl sodium maleic acid monoester and tetradecyl sodium maleic acid monoester as well as sodium tetradecyl sulfosuccinic diester were better than lauryl sodium sulfate, and they were all suitable for being used as emulsifier.

An Investigation of Coagulation Cascade Activation and Induction of Fibrinolysis Using Foam Sclerotherapy of Reticular Veins

Coagulation parameters have not been investigated when foam sclerotherapy is used to treat reticular leg veins. To evaluate the effect of foam bubbles on coagulation and fibrinolysis by measuring platelet count and concentrations of clotting factors and fibrinogen after foam sclerotherapy with sodium tetradecyl sulfate (STS) mixed with room air. Patients with reticular veins received treatment with up to 30mL of foam sclerotherapy prepared with STS and room air in a 1:4 ratio (1mL STS, 4mL room air) using the double-syringe technique. Venous blood was drawn immediately beforesclerotherapy and 15minutes after the procedure. Pre- and post-treatment laboratory values were compared. Subjects treated with up to 30mL of foam (30mL foam=6mL sclerosing solution and 24mL air) showed no statistically significant difference in coagulation or fibrinolysis, as measured according to platelet count and concentrations of clotting factors and fibrinogen, after foam sclerotherapy with STS mixed with room air. STS foam made with room air, up to 30mL, when injected into reticular veins does not affect coagulation parameters.

Off label use of devices and drugs in interventional radiology

To establish how often off-label device and drug use occurs in interventional radiology (IR) in a UK tertiary referral hospital and consider the wider implications for the interventional radiologist. Prospective data were collected during interventional procedures for 1 working week in a university hospital. Out-of-hours procedures and procedures outside the department were excluded. Operators were asked to record the drugs and devices used, the indication, and method of use. The instructions for use/summary of product characteristics were then studied for each device/drug used to assess if the use was on or off-label. During the study period 52 cases were performed and data were available on 26 cases (50%). In 22 of the 26 cases (84%) there was evidence of off-label use of devices or drugs. Off-label use of drugs included treatment of venous malformations with Fibrovein(©) (sodium tetradecyl sulphate), which is licensed for the treatment of varicose veins in the leg, and intra-arterial injection of heparin, which is licensed for intravenous and subcutaneous use. Off-label device use included placing vascular sheaths in the urinary tract, using angiographic catheters to guide wires in the urinary tract, using sheaths for thrombosuction, reshaping of the tip of most guidewires, and using angioplasty balloons to dislodge the arterial plug at fistula thrombectomy. Off-label device and drugs use is common in a UK tertiary hospital IR department and literature suggests this is common in the wider IR community. There are important clinical and legal implications for off-label use for patients and physicians.

An investigation of side-effects and efficacy of foam-based sclerotherapy with carbon dioxide or room air in the treatment of reticular leg veins: a pilot study

In sclerotherapy, carbon dioxide (CO(2)) or room air can be employed by phlebologists for foam creation. We compared room air (RA) and carbon dioxide in treating reticular leg veins with foam sclerotherapy. Twenty patients were randomly treated with RA- or CO(2)-created sodium tetradecyl sulphate (STS) foam. Concentration and volume of STS, side-effects and efficacy were determined. There was no difference in the efficacy, local side-effects or distant side-effects between RA and CO(2) foam in the treatment of reticular leg veins. The total volume of foam sclerosant required for treatment was greater with CO(2) compared with RA (P value = 0.01). No differences were found in efficacy or side-effects between RA- and CO(2)-foam sclerotherapy for reticular leg veins. CO(2) foam's shorter half-life was hypothesized to be responsible for larger total volumes of CO(2) foam sclerosant.

Mechanochemical tumescentless endovenous ablation: final results of the initial clinical trial

ObjectiveThe purpose of this study was to assess the safety and efficacy of the ClariVein® system that employs mechanochemical ablation of the great saphenous vein (GSV).MethodPatients eligible for ablation of the GSV underwent micropuncture access with only local anaesthesia to insert a 4 or 5 Fr sheath. The ClariVein® catheter was placed through the sheath, the wire was extruded, and the distal tip of the wire positioned 2 cm from the saphenofemoral junction under ultrasound guidance. Catheter wire rotation was then activated for 2–3 seconds at approximately 3500 rpm. With the wire rotating, infusion of the sclerosant was started simultaneously with catheter pullback. The sclerosant used was 1.5% liquid sodium tetradecyl sulphate (Sotradecol©, Bioniche Pharma Group, Geneva, Switzerland).ResultsThirty GSVs in 29 patients were treated. All patients have reached six-month follow-up; the average number of postoperative days is 260. No adverse events have been reported. The Primary Closure Rate is 96.7%.ConclusionMechanochemical ablation appears to be safe and efficacious. The ClariVein® technique eliminates the need for tumescent anaesthesia. The great majority of incompetent GSVs can be treated with this technique.

Die intraläsionale Sklerosierung venöser Malformationen an der Hand mit Natriumtetradecylsulfat

Congenital venous malformations (VM) at the hand are rare. VM consist of dysplastic venous vessels without progressive cellular proliferation. The therapy for VM is considerably different from that for vascular tumours (e. g., haemangiomas). Treatment options for vascular malformations are antithrombotic medication, local compression, resection of the VM, and obliteration of the lumina by percutaneous sclerosation. Here, the percutaneous sclerosation for the treatment of VM with sodium tetradecyl sulfate has been illustrated and discussed on the basis of 2 case reports.

Characterizing the Distribution of Sodium Alkyl Sulfate Surfactant Homologues in Water-Based, Acrylic Pressure-Sensitive Adhesive Films

The distributions of three sodium alkyl sulfate surfactants in dry adhesive films cast from water-based latexes were characterized using confocal Raman microscopy (CRM) and contact angle (CA) and tack measurements. Sodium dodecyl sulfate (SDS), sodium tetradecyl sulfate (STS), and sodium octadecyl sulfate (SODS) were added to dialyzed commercial adhesive latex at various concentrations. Uneven distributions were found for all three surfactants along with a tendency to enrich film-air interfaces and, to a much lesser extent, film-glass interfaces. SDS demonstrated the greatest tendency to concentrate near film surfaces followed by STS and SODS. For all three surfactants, water CA values for dried films decreased sharply with increasing concentrations in the latex, but significant differences were observed, with SDS again having the greatest impact followed by STS and SODS. Tack of dried polymer films was also found to decrease with increasing latex surfactant levels, with SDS producing the sharpest drop as well as the lowest plateau values. Results indicate that interfacial enrichment by surfactants is detectable via both CRM and CA measurements, and this enrichment can significantly affect the performance of films. Finally, surface enrichment levels are qualitatively related to measures of the surfactants' affinity for aqueous solutions, as characterized by the logarithm of their 1-octanol-water distribution coefficients (K(ow)).

Lymphatic malformations: Clinical course and management in 64 cases

Lymphatic malformations (LM) are rare vascular malformations. To define the clinical characteristics of children with LM and their management. We performed a retrospective chart review of children with LM and telephone interviews with parents. Demographic and clinical features, diagnostic imaging, treatments and complications were recorded. Thirty male and 34 female patients with LM were identified. The anatomic location of the LM was most frequently the head and neck (48%). LM involved the left side of the body more frequently (62%). Children presented most commonly with swelling as skin coloured tumours or cysts, and less frequently with hemihypertrophy, bruising, and superficial pseudo-vesicles. Most LM were macrocystic (60%), followed by microcystic (24%) and mixed (16%). The mean age at diagnosis was 37 months, with 51% of LM obvious at birth. LM caused morbidity in 70% of cases and death in one child. Treatments were sclerotherapy with sodium tetradecyl sulfate 3% (30.5%), OK-432 (17%) and doxycycline (10%); 27% received surgery; 34 % had no treatment. LM are heterogeneous vascular malformations that may result in significant morbidity. Diagnosis is often delayed. A multidisciplinary approach to management including dermatology, diagnostic and interventional radiology and paediatric surgery is important.

Treatment of lymphangioma circumscriptum with sclerotherapy: an ignored effective remedy

Lymphangioma circumscriptum is a rare lymphatic malformation that involves the skin and may extend to subcutaneous tissue and muscle. It usually presents as grouped micro- to macroscopic vesicles filled with lymph. Surgical excision has been the standard treatment, but it is associated with scarring, infection, injury to the surrounding structures, and a high recurrence rate. Herein, we report a 24-year-old male patient with a lymphangioma circumscriptum on the nape of the neck that was treated with two sessions of an intralesional injection of 1% sodium tetradecyl sulfate sclerotherapy with a very good result. After this treatment, there was no more discharge and a reduction in the lesion's size by 70%. Sclerotherapy using sodium tetradecyl sulfate can be considered a successful minimally invasive treatment option for lymphangioma circumscriptum.

Absence of Concentration Congruity in Six Compounded Polidocanol Samples Obtained for Leg Sclerotherapy

In the arena of venous sclerotherapy, sodium tetradecyl sulfate (STS), hypertonic saline, and polidocanol (POL) are the most widely used agents in the world for treating endothelial vein wall destruction. Pharmaceutical-grade STS and hypertonic saline are available from manufacturers. Until 2010, POL was only available in the United States through compounding pharmacies. To identify whether a risk exists when using freely available compounded POL samples for venous sclerotherapy. Six samples of 1% POL solutions obtained from four compounding pharmacies were evaluated using gas chromatography mass spectrometry (GC/MS) assays for POL concentration and identification of material impurities. Disparities in POL concentrations between six samples ranged from 1.0% to 3.1%. The GC/MS analysis showed impurities in all six compounded POL samples. In this study, compounded POL solutions did not deliver the claimed concentration five out of six times. This inconsistency poses risks to the patient and the treating physician during venous sclerotherapy with pharmacy-compounded POL. Merz Aesthetics provided funding for this study.