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What is the first option for venous malformation management?
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Sarah Bernhard, Aleksandra Tuleja, Jochen Karl Rössler, Iris Baumgartner
In summary, the best option is to avoid interventional treatment whenever possible. If symptoms are limiting the patient's quality of life or threatening life, organs, or limbs, endovascular embolo-sclerotherapy is recommended as first-line treatment of VMs. Various sclerosing agents are well described in terms of efficacy and safety, but large, randomized trials are missing.21, 55
Acute non-variceal gastrointestinal bleeding
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
A range of sclerosing agents have been injected into and around bleeding ulcers to try and stop active haemorrhage and prevent rebleeding. These include 1% polidocanol, 5% ethanolamine and 3% STD. There are no controlled trials involving patients randomized to sclerosants or to conservative (no injection) treatment. Trials have shown that a combination of dilute adrenaline plus a sclerosant is superior to no endoscopic therapy in terms of reduction of the rate of rebleeding and need for surgery (Table 6.5).
Congenital cysts and sinuses of the neck
Published in Prem Puri, Newborn Surgery, 2017
Yousef El-Gohary, Joseph Fusco, George K. Gittes
Ranulas are divided into simple and plunging ranulas. Simple ranulas are either mucus retention cysts that are restricted to the oral cavity floor or else mucus extravasation pseudocysts. Plunging ranulas are mucus extravasation pseudocysts that originate from the sublingual glands and herniate through the mylohyoid muscle to present as a cervical neck swelling, which may be confused with a submandibular mass when there is no intraoral component.53 The ideal management for both of these lesions remains controversial, ranging from injecting sclerosing agents to different surgical techniques. Although most would agree to surgically excise them, a consensus on the ideal technique and approach is lacking.
Injection therapies for patellar tendinopathy
Published in The Physician and Sportsmedicine, 2020
Color Doppler studies reported neovascularization in 60–80% of patents with PT [38]. Sclerosing agents are used to inhibit this neovascularization and destroy the new blood vessels being formed [34]. It also inhibits the vasa nervorum accompanying the blood vessels which has a denervating effect, hence relieving pain. Sclerosing agents are injected into the blood vessels just before their entry into the patellar tendon [14]. Alfredson and Öhberg [39] reported a promising result with a considerable decrease in pain following a sclerosing injection of 5 mg/ML. All 15 patients who received the sclerosing injection returned to their activity level and there was a reduction in the pain scale during the six month follow-up. Polidocanol was the sclerosing agent used in the Alfredson and Öhberg study. At the same time, Hoksrud, Torgalsen [38] failed to confirm their findings in a group of athletes with chronic PT. According to Willberg, Sunding [40], arthroscopic shaving is a better treatment option in PT compared to sclerosing agents. The use of sclerosing agents in PT is still unclear and further research is recommended to determine its effectiveness.
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].
Use of percutaneous bleomycin sclerotherapy for orbital lymphatic malformations
Published in Orbit, 2019
Adam M. Hanif, Justin A. Saunders, C. Matthew Hawkins, Ted H. Wojno, Hee Joon Kim
Recently, use of intralesional sclerosing agents has been reported. To date, the use of OK-432, sodium tetradecyl sulfate, alcohol, and sodium morrhuate has been reported for orbital lymphatic malformations with some success.4,8,10–13 Bleomycin, an anti-neoplastic antibiotic isolated from Streptomyces verticillus, is another sclerosing agent that has shown promising results in the literature.14–17 Through mechanisms that have yet to be fully elucidated, it inhibits nucleic acid synthesis and causes a nonspecific inflammatory reaction within endothelial cells lining the cysts, leading to fibrosis and involution of the lesion.13 In treatment of lymphatic malformations, it is injected directly into cysts after aspiration of the cyst contents with fluoroscopic and sonographic guidance. Though such off-label use is still investigational, its use in lymphatic malformations of the head and neck region is well documented. However, documentation in the literature regarding its use specifically in the orbit is comparably lacking. In this study, we therefore sought to summarize the clinical manifestations and outcome of the use of percutaneous bleomycin sclerotherapy for orbital lymphatic malformations by way of an institutional review board-approved retrospective chart review.