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Foam sclerotherapy: First option for venous malformations?
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Sclerotherapy refers to the technique of injecting chemically ablative sclerosants into the target lesion to achieve endovascular fibrosis to ultimately occlude the vessel. There are three broad categories of sclerosants: detergents, osmotic agents, and chemical irritants. Sodium tetradecyl sulfate (STS) and polidocanol (POL) are the most popular detergent sclerosants used to treat venous incompetence and venous malformations. Hypertonic saline and dextrose are examples of osmotic agents used to treat telangiectasias. Ethanol and doxycycline are examples of chemical irritants commonly used in the treatment of arteriovenous and lymphatic malformations, respectively.
Sclerotherapy Of Esophageal Varices
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
The effect of sodium tetradecyl sulfate, an anionic surfactant agent, is similar to that of morrhuate sodium. Since allergic reactions are known, the drug has not been introduced into the sclerotherapy of esophageal varices.
Postphlebitic Disease
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Two main strategies have been designed to alleviate venous hyperpressure and/or its consequences: (1) attempts at directly restoring the function of deep venous valves, through valvuloplasty and valve transposition or transplantation,42,43 are still meeting major technical difficulties and should be viewed as experimental, although they carry great hopes; (2) surgery to the superficial and perforating venous systems has been used for much longer. It usually combines ligation and stripping of the long saphenous vein, with ligation of the incompetent perforating veins in the calf. Both good43–44 and bad45 results have been reported with these procedures in postphlebitic patients. The indications for surgical treatment must be discussed cautiously, because failure (incision infection, venous thrombosis) may severely aggravate the postphlebitic disease by further increasing deep venous pressure and lym-phostasis. As a complement (or even as a substitute for surgery), some advocate sclerotherapy46 of the varicose veins (injection of a sclerosing agent such as sodium tetradecyl sulfate). Sclerotherapy is very widely practiced, especially in continental Europe, but its efficiency is poorly documented.
Severe orbital inflammation and hemorrhage complicating bleomycin sclerotherapy for orbital lymphaticovenous malformation
Published in Orbit, 2023
Considering that the orbit is a confined space, there is concern regarding the use of sclerosants in the deep orbit due to the risk of significant swelling, increased mass effect, and post-procedural rise in the intraorbital pressure.5 The risk of swelling is greater with certain sclerosants, such as sodium tetradecyl sulfate.5,11,15 In a series of nine patients undergoing percutaneous sclerotherapy with sodium tetradecyl sulfate, Chiramel et al21 reported a marked rise in the intraorbital pressure in a third of their patients and one patient required lateral canthotomy and inferior cantholysis. Harmoush et al22 also reported raised post-procedural intraocular pressure in three of the 17 cases in their series. Orbital compartment syndrome requiring orbital decompression surgery has even been reported in a patient who underwent sodium tetradecyl sulfate sclerotherapy for a low-flow malformation involving the cheek, upper and lower lips, the hard and soft palates, and the pharynx.14 Therefore, an ophthalmologist should be available as part of the multidisciplinary team whenever orbital sclerotherapy is performed. Most practitioners administer systemic steroids, e.g. dexamethasone, either before, or both before and after sclerotherapy to reduce the post-procedural inflammation and swelling and mitigate the risk of orbital compartment syndrome.
Recent developments on foaming mechanical and electronic techniques for the management of varicose veins
Published in Expert Review of Medical Devices, 2019
C. Davide Critello, Salvatore A. Pullano, Thomas J. Matula, Stefano De Franciscis, Raffaele Serra, Antonino S. Fiorillo
Sodium tetradecyl sulfate (STS) and polidocanol (POL) are the most used sclerosing agents for treatment of the varicose disease. STS and POL are anionic (negatively charged) and nonionic (no charged head) surfactants, respectively. Other examples of sclerosing agents are sodium morrhuate (SM) and ethanolamine oleate (EO), even if they have demonstrated reduced reliability, safety, and effectiveness [28]. To be clinically effective, sclerosing agents must denature biological molecules that provide structural integrity to the vein wall with the aim of inducing vascular injury. The action of these surfactants is characterized by the disruption of cell membranes through a mechanism known as ‘protein theft denaturation’, taking away essential proteins from the membrane surface causing the death of endothelial cells. The damage of the vein wall, then, exposes the underlying collagen triggering the coagulation processes, which lead to the local release of fibrinogen with the formation of a non-occlusive thrombus and subsequent fibrosis of the target vessel [29]. The injury caused by the action of sclerosant needs to involve smooth muscle cells of the vein wall to an extent where apoptotis is induced. Programmed cell death of a portion of the media layer has appeared to be crucial for the success of sclerotherapy, so the damage of the vein wall has not to be confined to the endothelium only [30].
Congenital Cirsoid aneurysm communicating with the sagittal sinus and supplied by extra and intracranial arteries
Published in British Journal of Neurosurgery, 2019
O. E. Idowu, O. A. Ayodele, H. A. Oshola
Treatment modalities for CA includes, endovascular technique, intralesional injection of sclerosant and ligation of feeding vessels. Endovascular methods involve the placement of glues, thrombogenic coils or radio-opaque gel foam into the feeding arteries. This approach is not feasible in our environment due to limited facility in our environment. The endovascular approach can also be complicated with tenderness and hyperemia over the skin, skin necrosis, variable hair loss which may be long-lasting, leakage of embolization material into the general circulation and recurrence due to feeding collaterals.3 Intralesional injection of sclerosing agents using either sodium tetradecyl sulfate, absolute alcohol, thrombogenic coils is another treatment option for CA. In this patient we opined that this was not appropriate. Ligation of the feeding arteries and excision has been one of the earlier treatments performed for this condition. This approach was used for the patient with excellent result and resolution of the patient’s seizure.