Ethanol threshold doses for systemic complications during sclerotherapy of superficial venous malformations: a retrospective study (original) (raw)
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Clinics, 2010
INTRODUCTION: Venous malformations are the most frequent vascular malformation. Deep venous malformations are located in subcutaneous tissue or in the muscles. Percutaneous sclerotherapy is the treatment of choice, and the use of ethanol at low doses has not yet been described. OBJECTIVE: To analyze the results of treating Deep venous malformations patients with low doses of ethanol. METHODS: Thirty-nine patients treated between July 1995 and June 2007 were followed up prospectively over a median period of 18 months. Twenty-nine were female (74.4%) and 10 were male (25.6%), with ages ranging from 11 to 59 years (median of 24 years). All of the lesions affected limbs, and the main symptom reported was pain (97.4%). Each patient underwent fortnightly alcohol application sessions under local anesthesia on an outpatient basis. The lesions were classified into three groups according to size using nuclear magnetic resonance imaging: small, up to 3 cm (4 patients); medium, between 3 and 15 cm (27 patients); and large, greater than 15 cm (8 patients). RESULTS: The symptoms completely disappeared in 14 patients (35.9%) and improved in 24 (61.5%). The lesion size reduced to zero in 6 patients (15.4%) and decreased in 32 (82%). The median number of sessions was 7. There were no complications in 32 patients (82%), while 3 presented local paresthesia (7.7%), 2 superficial trombophlebites (5.1%), 1 skin ulcer (2.6%), and 1 case of hyperpigmentation (2.6%). CONCLUSION: Outpatient treatment for Deep venous malformations patients using ethanol at low doses was effective, with a low complication rate.
Ethanol sclerotherapy of head and neck venous malformations
Einstein (São Paulo), 2014
Objective This retrospective study evaluated the results of sclerotherapy with low doses of ethanol for treatment of head and neck venous malformations.Methods We treated 51 patients, 37 females. Median age was 23 years. Patients were treated with percutaneous intralesional injection of alcohol every two weeks and followed up prospectively for a median period of 18 months. Most lesions affected the face and cosmetic disfigurement was the most frequent complaint.Results We performed a median of 7 sessions of sclerotherapy. Complete resolution or improvement was observed in 48 patients presented. Five cases of small skin ulceration, two cases of hyperpigmentation and two of paresthesia were documented; all of them were treated conservatively.Conclusion Percutaneous sclerotherapy with low doses of ethanol is a safe and effective treatment modality for venous malformations affecting the head and neck.
European Journal of Plastic Surgery
Due to complicated anatomy of the face and neck, complete surgical excision of venous malformation is rarely possible and may lead to bleeding, nerve damage and cosmetic deformity. Sclerotherapy is an alternative method of treatment with few complications. Ethanol shows the lowest rate of malformation recurrence and is the most reliable substance of all of the sclerosing agents. This study aims to evaluate the efficacy of ethanol instillation in venous malformation of the face and neck. Between July 20, 2008, to December 30, 2009, 15 patients with venous malformation of the face and neck were included in the study. After confirmation of diagnosis (combination of history, physical findings and magnetic resonance imaging), percutaneous ethanol (99.5% ethyl alcohol) sclerotherapy was used under DSA road mapping using general anaesthesia. Sclerotherapy provided significant improvement of symptoms for all patients, with no major complications. All patients experienced pain and swelling to a variable degree in the immediate post procedure period that resolved over few days. Ethanol sclerotherapy for venous malformations of the face and neck is a safe and effective treatment option.
Ethanol sclerotherapy for the management of craniofacial venous malformations: the interim results
Korean journal of radiology : official journal of the Korean Radiological Society
We wanted to evaluate the safety and feasibility of ethanol sclerotherapy for treating craniofacial venous malformations (CVMs). From May 1998 to April 2007, 87 patients (40 men and 47 women; age range, 2-68 years) with CVMs underwent staged ethanol sclerotherapy (range, 1-21 sessions; median number of sessions, 2) by the direct puncture technique. Clinical follow up (range, 0-120 months; mean follow up, 35 months; median follow up, 28 months) was performed for all the patients. Therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms in all patients, as well as the degree of devascularization, which was determined on the follow-up imaging, in 71 patients. A total of 305 procedures with the use of ethanol were performed in 87 patients. Follow-up imaging studies were performed for 71 of 87 patients. Twenty-three (32%) of the 71 patients showed excellent outcomes, 37 patients (52%) showed good outcomes and 11 patients (16%) showed poor outcome...
Neurointervention, 2011
Purpose: Alcohol is not used directly to the vascular lesion without mixing with the contrast agent because alcohol itself cannot be seen on the fluoroscopy. Since we have used alcohol for the venous malformations in the head and neck area, we realized that alcohol can be safely and effectively used without using fluoroscopy. We present the method of direct sclerotherapy using absolute alcohol without using fluoroscopy. Materials and Methods: After obtaining and carefully analyzing direct puncture venogram, we used this technique in 22 patients who underwent alcohol sclerotherapy. Because fluoroscopy was not used during alcohol injection, the angiotable can be placed outside of C-arm so that alcohol was comfortably injected without any obstacle around the patients. Venogram can also be obtained between the injections to detect whether there is any dangerous venous outflow drainage such as the superior ophthalmic vein to the cavernous sinus. To control the venous outflow, local compression to the draining vein was applied. The result and complication such as skin necrosis, infection, and nerve injury were evaluated during mean follow-up period of 13 months (range, 1-63 months). Results: The frequency of sclerotherapy was one in 16 and 2-5 in 6 patients. The volume of alcohol used per treatment session ranged from 2 to 18 mL (mean, 8.5 mL). There was the minimum change in 1 (4.5%), moderately decreased lesion in 12 (54.5%), and markedly decreased lesion in 9 (41%) patients. The patients did not reveal any complications during 12.9 months follow-up period. Conclusion: Direct puncture alcohol sclerotherapy without using fluoroscopy can be a safe and effective technique for treating venous malformation of the head and neck areas. In addition, the procedure can be performed in the comfortable position because biplane fluoroscopy would not be necessary.
Percutaneous ethanol sclerotherapy of venous malformations of the tongue
American Journal of Neuroradiology
Percutaneous ethanol sclerotherapy has been reported to be efficacious for head and neck venous malformations. We sought to evaluate the safety and efficacy of percutaneous sclerotherapy by using ethanol for treatment of symptomatic venous malformations of the tongue. Eleven sclerotherapy procedures were performed in seven patients from January 1995 to February 2001. Patient age ranged from 19 months to 57 years (mean age, 32 years). Four patients were male and three were female. Mean follow-up was 36 months. The volume of ethanol used per treatment session ranged from 2 to 32 cc (mean, 16 cc). Sclerotherapy provided significant improvement or resolution of symptoms for all patients. There were no major complications. One patient had a small (3 x 2 cm) area of skin blistering at the injection site. All patients experienced pain and swelling to a variable degree. Sclerotherapy resulted in resolution of symptoms in six of seven patients. Three patients had resolution of symptoms after...
Erciyes Medical Journal, 2017
Objective: Percutaneous ethanol sclerotherapy has shown to be efficient in treating venous malformations of the head and neck. Our aim was to assess the safety and efficacy of percutaneous ethanol sclerotherapy in treating venous malformations of the oral cavity and the oropharynx. Materials and Methods: From 2007 to 2015, 57 percutaneous procedures using ethanol were performed in 13 patients. Medical records of these patients were retrospectively analyzed. One patient was male and 12 were females. The patients' age ranged from 8 to 65 years (mean age, 30 years). The mean follow-up was 11 months. The volume of ethanol used per session ranged from 0.4 to 14 mL (mean volume, 6 mL) in 12 patients, except the syndromic patient. Results: In 7 out of 13 patients (53.4%), the lesions were resolved completely. In 3 patients (23%), sclerotherapy alleviated the symptoms. In 2 patients (15.3%), the lesions did not sufficiently respond to the therapy. In 1 patient (7.6%), sclerother-apy failed due to misdiagnosis. No major complications were encountered. All the patients experienced pain to a tolerable degree. Swelling, induration, and darkening of the lesion occurred following injections. In 1 patient, ulceration and cleavage on the tongue was resolved within 15 days after emergence. Conclusion: Percutaneous ethanol sclerotherapy is a reliable and efficacious method of treating venous malformations of the oral cavity and oropharynx.
Predictive Factors for Successful Percutaneous Sclerotherapy of Venous and Lymphatic Malformations
The ASEAN Journal of Radiology
Objectives: To determine the predictive factors for good response outcome of venous (VMs) and lymphatic malformations (LMs) by percutaneous sclerosing therapy and to compare the complications associated with bleomycin versus alcohol treatment. Methods: A retrospective analysis of 225 patients with lymphatic and venous malformation who had treated by percutaneous sclerotherapy using alcohol and/or bleomycin was performed The treatment outcome was graded from 0-3, in orderly of clinical responsiveness by using visual assessment of changing in size and subjective improvement of symptoms. Predictive factors of good treatment outcome were determined by uni- and multivariate analysis which were conducted on sex, age, onset of disease, location, type, characteristic of lesion and sclerosant usage. Results: Of 225 patients, 87.6% were VMs and 12.4% were LMs. VMs were predominating in female (6.2:3.8). Between ethanol and bleomycin, there was no statistical significant of treatment sessions,...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015
OBJECTIVE To assess and compare the effectiveness of the two sclerosing agents (95% alcohol and Bleomycin) for the treatment of head and neck venous malformation (VM). MATERIAL AND METHOD The authors retrospectively reviewed our experience in treating VM of the head and neck region using two sclerosing agents, 95% alcohol (November 2001 to June 2008) and bleomycin (July 2008 to July 2010). Patients' demography (age, sex), lesion number location, type (focal/extensive), and characteristic features (cystic/tubular/mixed) were recorded. The treatment outcome was determined by decrease in size of VM in photographs taken at one month and at final clinical follow-up. These were analyzed by two radiologists using visual rating scale (worst or not improved, <50%, 50-75%, >75% of size reduction). One-way Anova test (p < 0.1) was used to show the differences in treatment effectiveness of the two sclerosing agents at short- and long-term intervals. RESULTS Thirty-three patients, a...