Foam sclerotherapy: First option for venous malformations?
Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic in Vascular Malformations, 2019
Foam sclerosants are the agents of choice in the treatment of small VMs sized up to 2–3 mm in diameter or diffuse lesions where other modalities are not suitable. The authors prefer to treat larger lesions with endovenous laser ablation (EVLA) and n-butyl cyanoacrylate (n-BCA) glue. Ethanol has been mostly superseded by foam sclerosants in the management of VM and should only be used discriminately due to its significant complication profile. In experienced and expert hands, ethanol sclerotherapy is quite effective in treating a range of VMs, but it requires extensive training and monitoring, especially if large volumes are required. In our group's experience, we have not employed ethanol in the past 25 years to treat VMs. Surgical excision of VMs is associated with high recurrence rates and is not recommended. However, surgical debulking of the residual fibrofatty tissue following successful embolization can be indicated in cases where the remaining mass is causing symptoms.5
Vascular tumours and congenital vascular malformations
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland in Manual of Venous and Lymphatic Diseases, 2017
Embolisation can be performed with particles, coils or liquid adhesive materials via a venous or arterial approach or by direct injection. Contour particles such as Ivalon tend not to be useful for treating malformations. Coils occlude larger vessels but are unable to penetrate into the nidus and can actually stimulate grow th, and are best used placed in outflow veins to reduce vascularity prior to other treatment. Liquid agents are best able to penetrate into the nidus. N-butyl cyanoacrylate in oil produces immediate mechanical obstruction and a subsequent inflammator y response causing long-term occlusion, although this may not be sufficient to cure the lesion and is frequently no more than palliative. Ony x is a less adhesive agent which is a copolymer of ethylene and vinyl alcohol dissolved in dimethyl sulphoxide. It is extremely effective in reaching into small vessels in the nidus, allowing better control, but again it is not necessarily curative, although in combination with other treatments causes lesion shrinkage and hardening to permit surgical excision.
Pre-, intra-, and post-treatment use of duplex ultrasound (thermal and non-thermal)
Joseph A. Zygmunt in Venous Ultrasound, 2020
Recently, endovenous glue-induced thrombus (EGIT) has been discussed at meetings, and early literature is being noted. In January 2015, the FDA approved a new NTNTNS device, VenaSeal ClosureTM System (Medtronic; Minneapolis, MN, USA), which is an n-butyl cyanoacrylate−based adhesive developed for endovenous closure of incompetent saphenous veins. The use instructions for this device include a setback from the saphenous junction of 5 cm [14]. The purpose of this setback is to allow space for deployment of the adhesive proximal to the tip of the delivery catheter, rendering a closure distance of about 2.5 cm from the junction, similar to thermal ablation techniques. Almeida et al. reported “threadlike thrombus extension” across the junction [10]. This resulted in the increased setback distance to 5 cm, as noted previously, for all subsequent uses of the VenaSeal System. A 2015 European study noted glue extension and surmised it to “represent a complex of cyanoacrylate adhesive agent and bland thrombus” [15]. A recent publication makes note of the EGIT glue/thrombus complex [16]. Practitioners are currently following similar treatment algorithms, as noted with the Kabnick or Lawrence scale for EHIT. Of note, the authors (Pilluta et al.) state that “based on this study and earlier work by Almeida, EGIT appears to develop within hours to days after treatment and usually resolves within 5–6 weeks.”
Uterine artery pseudoaneurysm haemorrhage requiring semi-urgent caesarean section: a multidisciplinary approach
Published in Journal of Obstetrics and Gynaecology, 2019
Aaron Rohr, Hasnain Hasham, Aaron Frenette, Ryan Ash, Philip Johnson, Thomas Fahrbach
After the successful surgery and delivery, the patient was brought back to the endovascular suite in IR. The balloon was deflated and a digital subtraction angiography (DSA) was performed demonstrating the persistent filling of the pseudoaneurysm (Figure 1(a)). Subsequently, the uterine artery was embolised using a combination of 4:1 Ethiodol:N-BCA (Codman Neuro, West Chester, PA) and a single detachable Interlock coil (Boston Scientific, Marlborough, MA). Glue (n-butyl cyanoacrylate) and Onyx (ethylene-vinyl alcohol copolymer) are liquid embolic agents used for a transcatheter embolisation. Although glue and Onyx have grossly similar intravascular effects and complication rates, certain differences in properties such as the viscosity, the rate/volume of injection, and their adhesive nature make each embolic material unique. An extensive glue vs. Onyx comparison is outside of the scope of this article. In the present case, a liquid embolic agent was preferred for more distal embolisation of the vessel in an attempt to trap the proximal and distal component of the ruptured artery and subsequently prevent a retrograde filling of the pseudoaneurysm. A single coil was used for a ‘scaffolding’ effect to better help with the glue adherence (Barral et al. 2017). The follow-up contrast injection revealed an appropriate haemostasis of contrast without a residual filling of the pseudoaneurysm (Figure 1(b)). A StarClose arteriotomy closure device (Abbott Vascular, Abbott Park, IL) and manual compression were utilised to achieve haemostasis at the access site.
Sealing clear corneal incisions in cataract surgery
Published in Expert Review of Ophthalmology, 2018
Manpreet Kaur, Ankit Tomar, Farin Shaikh, Ruchita Falera, Lalit M. S. Bageshwar, Jeewan S. Titiyal
Experimental laboratory studies have demonstrated the efficacy of cyanoacrylate adhesives in preventing wound leak and ocular surface fluid ingress independent of IOP variation and manual manipulation of the wound edge [55]. Cyanoacrylate-sealed CCIs are superior to both fibrin adhesives and sutured CCIs in preventing wound leak in the event of elevated IOP [56]. Methoxypropyl cyanoacrylate and N-butyl cyanoacrylate are associated with superior bacteriostatic and wound-sealing properties as compared to fibrin adhesives; however, they are also associated with greater cytotoxicity [54]. Shigemitsu et al. observed the tensile strength of corneoscleral wounds sealed to be equivalent to sutured wounds in an experimental rabbit study [57]. Leung et al. also observed noninferiority of cyanoacrylate as compared to sutured CCIs [58].
Nanotechnology application for pain therapy
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2018
Mahmoud Reza Moradkhani, Arash Karimi, Babak Negahdari
Hua and Cabot also reported the use of targeted nanoparticles to deliver opioids, in particular, loperamide HCl, specifically to peripheral opioid receptors to stimulate analgesic and anti-inflammatory actions for use in painful inflammatory conditions [18]. Ward et al. also reported other sustained engineered release systems to extend the duration of action of opioid analgesics [19]. Liu and colleagues in their report demonstrated that endomorphin-1, adsorbed onto the surface of butyl- cyanoacrylate nanoparticles and coated with polysorbate 80 could be administered intravenously as an analgesic agent [20]. Furthermore, Tosi and co-worker investigated the antinociceptive efficacy of peptide-derivatized nanoparticles loaded with loperamide HCl in an in vivo experiment for delivery to central opioid receptors. They concluded that there was a peak percentage of possible effect of 60% at 4 h and a significant continued release effect for 6 h after the administration of 0.7 mg of loperamide HCl in Wistar rats [21]. In addition, Chen et al. reported that nanoparticles made up of loperamide and PLGA-PEG-PLGA triblock copolymer coated with poloxamer 188 or polysorbate 80 enhanced penetrations across the blood–brain barrier in comparison to PLGA-PEG-PLGA nanoparticles and PLGA nanoparticles.
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