Polidocanol Plus Glucose Versus Glucose Alone for the Treatment of Telangiectasias: Triple Blind, Randomised Controlled Trial (PG3T).

OBJECTIVE: The aim of this study was to compare the effectiveness and safety of two sclerosing agents used to treat telangiectasias in the lower limbs: 0.2% polidocanol + 70% hypertonic glucose (HG) vs. 75% HG alone. METHODS: A prospective, randomised, triple blind, controlled, parallel group trial with patients randomly assigned in a 1:1 ratio between January and December 2015, with a two month follow up, from a single academic medical centre in Brazil, was carried out. Participants were women aged 18-65 years with telangiectasias on the lateral aspect of one thigh, classified as C1EpAsPn who underwent sclerotherapy in a single session with 0.2% polidocanol + 70% HG or 75% HG alone to treat the telangiectasias on an area limited by a rectangular template. The primary effectiveness endpoint was elimination of 75% of the telangiectasias within 60 days vs. the pre-treatment pattern. The length of vessels was measured on images obtained before and after treatment using ImageJ software. Safety outcomes were analysed immediately, 7 days, and 60 days after the treatment, and included pigmentation. RESULTS: A total of 115 patients were included, 98 of whom completed the study. Sclerotherapy with 0.2% polidocanol + 70% HG was significantly more effective than with 75% HG alone to treat telangiectasias in the target area (82.2% vs. 63.9%; p < .001); considering a minimum improvement of 75%, there was a 0.49 risk reduction (95% confidence interval 0.24-0.98; p = .047). No severe adverse events occurred in either group. Pigmentation was the most common minor adverse event and was significantly shorter in length in the group treated with 0.2% polidocanol + 70% HG (median 0 cm vs. 0.5 cm, respectively; p = .033). CONCLUSION: Polidocanol 0.2% plus 70% HG had better results than 75% HG alone in sclerosing telangiectasias. No severe adverse events occurred. Pigmentation occurred in both groups and was shorter in length in the group treated with 0.2% polidocanol + 70% HG.

Clinical outcome and predictors of treatment response in foam sodium tetradecyl sulfate sclerotherapy of venous malformations.

OBJECTIVES: To evaluate clinical outcomes and their predictors in patients with venous malformation (VM) treated with foam sodium tetradecyl sulfate (STS) sclerotherapy. METHODS: We retrospectively evaluated clinical outcomes of foam STS sclerotherapy in 86 patients with 91 VMs to assess reduction in pain and mass after treatment. Univariate and multivariate analysis was performed to determine possible predictors of clinical outcome with foam STS sclerotherapy. RESULTS: A positive response of 49.5% in pain reduction and 52.7% in mass reduction was observed. The numerical rating scale (NRS) score improved from 4.36 ± 2.64 to 1.74 ± 1.57, and VM mass volume decreased to 41.7 ± 35.52% of the initial size. On multivariate analysis, a high baseline NRS score (odds ratio: 1.12, 95% confidence interval: 1.09-1.15) and VM location in the trunk versus the head and neck (odds ratio: 1.30, 95% confidence interval: 1.00-1.69) were positive predictors of pain improvement. Minor complications occurred in 11 (12.1%) patients and recurrence in 12 (13.2%) patients. CONCLUSIONS: Foam STS sclerotherapy is an effective treatment in venous malformation, with low complication risk. A high baseline NRS score and location in the trunk versus the head and neck were positive predictors in improvement of pain. KEY POINTS: • Foam STS sclerotherapy is effective in VM, with low risk of complications. • Relief of pain tends to be dramatic in patients with severe pain. • Location of VM is a predictor of pain improvement. • The presence of a draining vein does not affect foam sclerotherapy.

Efficacy and safety of inflator-monitored balloon-occluded retrograde transvenous obliteration for gastric varices.

PURPOSE: To investigate the diagnostic efficacy of inflator-monitored balloon-occluded retrograde transvenous obliteration (ImBRTO) in detecting balloon rupture and to evaluate the efficacy and safety of the ImBRTO in treating gastric varices. METHODS: Between June 2018 and June 2024, 31 consecutive patients (age: 61.7 ± 12.4 years; male 20, female 11) underwent ImBRTO for gastric varices. An occlusion balloon was inflated with an inflation device to monitor for balloon rupture during sclerosing, maintaining the balloon inflation for at least 3 h. RESULTS: The technical success rate was 100%. The incidence of balloon rupture was 6.5% (2/31), both diagnosed by a pressure drop in the inflation device. In one of the two patients, catheter replacement and an additional injection of a sclerosing agent were required due to early balloon rupture (< 3 h). Clinical success and complete elimination of gastric varices were achieved in all cases. No procedure-related complications were observed. There were no cases of recurrent variceal bleeding at the end of the follow-up (median: 5.2 months). CONCLUSION: ImBRTO proves to be an effective and safe technique for treating gastric varices. The real-time monitoring of balloon integrity allows for timely decisions, resulting in excellent clinical outcomes.

Ethoxysclerol injection into the posterior ligament under single puncture arthroscopy for the treatment of recurrent temporomandibular joint dislocation: a novel technique.

The pathogenesis of recurrent chronic dislocation of the temporomandibular joint has been attributed to multiple factors, such as hyperlaxity of the soft tissues or alterations in the size of the temporal eminence. When there are no bone alterations, the injection of sclerosing solutions is an effective treatment that can be performed using a blind technique or with arthroscopy. This study presents an innovative technique for injecting ethoxysclerol into the posterior ligament through single puncture arthroscopy. This approach offers a safe and effective alternative for surgeons without experience in high-complexity arthroscopy who want to ensure precise injection of the agent into the desired anatomical areas.

Percutaneous treatment of simple renal cysts with 24-h-interval ethanol sclerotherapy.

Objective: To investigate the efficacy of 24-h interval multiple-session ethanol sclerotherapy for the treatment of simple renal cysts. Materials and Methods: The study sample included 58 patients (mean age, 65.37 ± 11.95 years). We included 76 simple renal cysts that were treated with percutaneous aspiration with a minimum of two sessions of 95% ethanol sclerotherapy in a 24-h interval between sessions. Patients were evaluated at 1, 3, and 6 months after the intervention for the efficacy of the treatment. Treatment success was defined as a complete regression of a cyst or a > 50% reduction in its volume, with no recurrence of symptoms. Results: The mean preprocedural cyst size was 72.98 ± 25.14 mm, and the mean preprocedural cyst volume was 205.76 ± 244.15 mL. The mean volume of ethanol used in the first sclerotherapy session was 62.76 ± 30.71 mL. The mean fluid accumulation in the cysts at the end of the first 24-h interval was 4.66 ± 7.13 mL. The mean quantity of ethanol used in the second sclerotherapy session was 26.48 ± 22.2 mL. A third sclerotherapy session was required in only 10 (13.2%) of the cysts. The mean follow-up period was 52.84 ± 37.83 months. The rate of complete regression was 97.4% for the whole sample at the end of the follow-up. Conclusion: Ethanol ablation with 24-h intervals is a safe and effective treatment option in the minimally invasive percutaneous treatment of simple renal cysts.

Objetivo: Demonstrar a eficácia da escleroterapia com etanol em sessões múltiplas em intervalos de 24 horas no tratamento de cistos renais simples. Materiais e Métodos: Foram avaliados 76 cistos renais simples de 58 pacientes (média de idade: 65,37 ± 11,95 anos) submetidos a aspiração percutânea e ao menos duas sessões de escleroterapia com etanol 95% num intervalo de 24 horas. Considerou- se sucesso de tratamento a regressão completa ou uma redução > 50% do volume do cisto, sem recorrência dos sintomas. Os pacientes foram reavaliados 1, 3 e 6 meses após o procedimento. Resultados: Antes do procedimento, a média do tamanho dos cistos foi de 72,98 ± 25,14 mm e a média do volume dos cistos foi de 205,76 ± 244,15 mL. A quantidade média de etanol utilizada na primeira sessão de escleroterapia foi de 62,76 ± 30,71 mL. A média de acúmulo de líquido ao final do intervalo de 24 horas foi de 4,66 ± 7,13 mL, sendo utilizada uma média de quantidade de etanol de 26,48 ± 22,2 mL na segunda sessão de escleroterapia. Uma terceira sessão de escleroterapia foi necessária em apenas 10 (13,2%) dos cistos. Na amostra geral, a taxa de regressão completa foi de 97,4%. O tempo médio de seguimento foi de 52,84 ± 37,83 meses. Conclusão: A ablação com etanol em intervalo de 24 horas é uma opção de tratamento segura, eficaz e minimamente invasiva no tratamento percutâneo de cistos renais simples.

Efficacy and safety of glucose, glucose and polidocanol combination, liquid polidocanol and polidocanol foam in the treatment of reticular veins: A randomized study in rabbits.

OBJECTIVE: To compare the efficacy and safety of sclerosing agents injected in dorsal veins of rabbit ears. METHODS: Sixty ears of 30 rabbits were randomly allocated in: 1% liquid polidocanol, 1% polidocanol foam, 0.2% polidocanol-glucose 70% solution, glucose 75% or 0.9% saline. Outcomes included efficacy (luminal occlusion), complications (phlebitis, neovascularization, ulceration at the puncture site, necrosis and local inflammation) and histology (sclerosis, recanalization vein and surrounding tissues inflammation, blood extravasation, recanalization, lymphangiogenesis, destruction of cartilage and neoangiogenesis). RESULTS: Sclerosis was superior in Foam Group (76.9%), but also with 30.7% necrosis (p = 0.003), 46.15% ulceration (p = 0.003), and 69.2% local inflammation (p < 0.0001). Neovascularization were similar. Histology showed 38.5% phlebitis (p = 0.004) and necrosis (p = 0.03) in the foam group. CONCLUSIONS: Sclerosis with foam and liquid polidocanol were superior to the other groups, but specially polidocanol foam at the expense of greater frequency of adverse events.

Comparison of Postoperative Benign Pelvic Cysts Occurred after Gynecologic or Gyne-oncologic Surgery Treated with Percutaneous Transcatheteric Sclerosant Alcohol Therapy.

OBJECTIVES: Here, we compare the success of percutaneous transcatheter sclerosant alcohol therapy (PTSAT) for the postoperative treatment of benign pelvic cysts that occurred after gynecologic surgery. MATERIALS AND METHODS: The study is a retrospective case-control trial. Gynecological patients who had symptoms due to postoperative pelvic cysts and received PTSAT after gynecologic surgery, between October 2008 and January 2018, were examined in a single training and research hospital in Turkey. Some factors were investigated for associations with postoperative pelvic cyst formation in patients who underwent gynecologic operations for malignancies or benign conditions. Statistical analysis used: The association between two independent and nonnormally distributed continuous variables was analyzed with the Mann-Whitney U-test. Spearman's rho correlation analysis was conducted to determine the correlation of two nonnormally distributed variables. Chi-square (or Fisher's exact test, when more suitable) was used to examine the correlation between categorical variables. RESULTS: Statistically significant differences were found in terms of the average age was higher in patients with malignancies, and the average postoperative pelvic cyst detection time was higher in patients with benign pelvic cysts. While all patients were treated with PTSAT, repetitive PTSAT was required for seven benign and ten malign cases. CONCLUSION: Patients with pelvic cysts that occurred after gynecologic surgery for malignant conditions, large volume pelvic cysts and patients with benign cysts who underwent more than one surgery required recurrent PTSAT.

Safety and effectiveness of percutaneous sclerotherapy for venous disorders of the labia majora in patients with vascular malformations.

OBJECTIVE: The aim of this study was to evaluate the safety and clinical outcomes of percutaneous sclerotherapy of venous disorders of the labia majora in patients with vascular malformations of the lower limbs. METHODS: Thirty percutaneous sclerotherapy treatments were performed over a 6-year period among 17 female patients with symptomatic venous malformation (VM) or secondary varicosis of the labia majora. Four patients were treated with sclerotherapy alone, 13 patients had additional procedures to control the VM before sclerotherapy. Polidocanol was used as sclerosant. Indications for sclerotherapy included pain, bleeding, thrombophlebitis, and swelling. Genitourinary symptoms were recorded. The number of treatments and procedure-related complications were registered. Complications were classified according to the Society of Interventional Radiology (SIR) classification system (grade A-E). The 3-month postintervention follow-up included magnetic resonance imaging, clinical examination, and a symptom-related questionnaire. If no reintervention was necessary, consultation was scheduled biannually. RESULTS: All patients had local swelling and pain; only a fraction of the patients had further symptoms with bleeding or thrombophlebitis (47% each). Eight patients required reintervention. No major complications were observed; minor complications such as postprocedural swelling occurred in 29% (SIR grade A), pain occurred in 17% (SIR grade B), and skin blistering developed in 5% (SIR grade B). Upon follow-up examination after a median of 40 months, 76% showed complete relief of symptoms, and 23% reported partial relief. All patients reported a substantial reduction in pain (75% >5 points in visual analogue scale) and swelling (88% complete cessation). CONCLUSIONS: Percutaneous sclerotherapy is a safe and effective treatment option of VM and secondary varicosis of the labia majora.

Bronchoscopic sclerosis of post-resectional bronchial fistulas.

BACKGROUND: Pulmonary resection is, by far, the primary cause of bronchial fistula. This is a severe complication because of its morbidity and mortality and the related consumption of resources. Definitive closure continues to be a challenge with several therapeutic options, but none are optimal. We describe our experience in bronchoscopic application of ethanolamine and lauromacrogol 400 for the treatment of post-resection bronchial fistulas. METHODS: Clinical records of 8 patients treated using this technique were collected prospectively. The diagnosis of a fistula was confirmed by flexible bronchoscopy. Sclerosis was indicated in the context of multimodal treatment. Sclerosant injection was performed under general anesthesia with a Wang 22G needle through a flexible bronchoscope. The procedure was repeated at 2-week intervals until definitive closure of the fistula was confirmed. RESULTS: Fistula closure was achieved in 7 (87.5%) of the 8 patients, with persistence of the fistula in one patient who could not complete the treatment because of recurrence of his neoplastic pathology. No recurrence or complications related to the technique were registered. CONCLUSIONS: Bronchoscopic sclerosis by means of submucosal injection of lauromacrogol 400 or ethanolamine should be part of the multimodal treatment of bronchopleural fistula after lung resection, pending further studies that contribute to the accurate establishment of optimal indications for this procedure.

Protocol for a systematic review and meta-analysis of interventions for pathologic perforator veins in chronic venous disease.

INTRODUCTION: Perforator veins (PVs) play an important role in the development of chronic venous insufficiency and ulceration. Procedures to eliminate incompetence and reflux in PV may include open surgery, subfascial endoscopic surgery, intravenous ablation techniques and sclerotherapy. With the aim of filling the evidence gap, this is a protocol for a systematic review that will assess the effects of any form of intervention for the treatment of pathologic PVs of the lower limbs in patients with chronic venous disease. METHODS AND ANALYSIS: Systematic searches will be carried out in MEDLINE, EMBASE, Cochrane CENTRAL, IBECS and LILACS databases at a minimum without date or language restrictions for relevant randomised controlled trials (RCTs) and quasi-RCTs (trials in which the method of allocation is not truly random). In addition, a search will also be carried out in the WHO International Clinical Trials Registry Platform, in the clinical trial registries of ClinicalTrials.gov and in the grey literature source OpenGrey.eu. The RCT and quasi-RCT comparison techniques isolated or in combination for treating PVs will be considered. Three review authors will independently perform data extraction and quality assessments of data from included studies, and any disagreements will be resolved by discussion. The primary outcomes will be wound healing and pain. Secondary outcomes will include oedema, adverse events, recurrence or recanalisation, quality of life and economic aspects. The Cochrane handbook will be used for guidance. If the results are not appropriate for a meta-analysis in RevManV.5 software (eg, if the data have considerable heterogeneity and are drawn from different comparisons), a descriptive analysis will be performed. ETHICS AND DISSEMINATION: Ethics committee approval is not necessary. We intend to update the public registry used in this review, report any important protocol amendments and publish the results in a widely accessible journal. PROSPERO REGISTRATION NUMBER: CRD42018092974.

Percutaneous treatment of simple renal cysts with 24-h-interval ethanol sclerotherapy / Tratamento percutâneo de cistos renais simples por escleroterapia com etanol em intervalo de 24 horas

Abstract Objective: To investigate the efficacy of 24-h interval multiple-session ethanol sclerotherapy for the treatment of simple renal cysts. Materials and Methods: The study sample included 58 patients (mean age, 65.37 ± 11.95 years). We included 76 simple renal cysts that were treated with percutaneous aspiration with a minimum of two sessions of 95% ethanol sclerotherapy in a 24-h interval between sessions. Patients were evaluated at 1, 3, and 6 months after the intervention for the efficacy of the treatment. Treatment success was defined as a complete regression of a cyst or a > 50% reduction in its volume, with no recurrence of symptoms. Results: The mean preprocedural cyst size was 72.98 ± 25.14 mm, and the mean preprocedural cyst volume was 205.76 ± 244.15 mL. The mean volume of ethanol used in the first sclerotherapy session was 62.76 ± 30.71 mL. The mean fluid accumulation in the cysts at the end of the first 24-h interval was 4.66 ± 7.13 mL. The mean quantity of ethanol used in the second sclerotherapy session was 26.48 ± 22.2 mL. A third sclerotherapy session was required in only 10 (13.2%) of the cysts. The mean follow-up period was 52.84 ± 37.83 months. The rate of complete regression was 97.4% for the whole sample at the end of the follow-up. Conclusion: Ethanol ablation with 24-h intervals is a safe and effective treatment option in the minimally invasive percutaneous treatment of simple renal cysts.

Resumo Objetivo: Demonstrar a eficácia da escleroterapia com etanol em sessões múltiplas em intervalos de 24 horas no tratamento de cistos renais simples. Materiais e Métodos: Foram avaliados 76 cistos renais simples de 58 pacientes (média de idade: 65,37 ± 11,95 anos) submetidos a aspiração percutânea e ao menos duas sessões de escleroterapia com etanol 95% num intervalo de 24 horas. Considerou- se sucesso de tratamento a regressão completa ou uma redução > 50% do volume do cisto, sem recorrência dos sintomas. Os pacientes foram reavaliados 1, 3 e 6 meses após o procedimento. Resultados: Antes do procedimento, a média do tamanho dos cistos foi de 72,98 ± 25,14 mm e a média do volume dos cistos foi de 205,76 ± 244,15 mL. A quantidade média de etanol utilizada na primeira sessão de escleroterapia foi de 62,76 ± 30,71 mL. A média de acúmulo de líquido ao final do intervalo de 24 horas foi de 4,66 ± 7,13 mL, sendo utilizada uma média de quantidade de etanol de 26,48 ± 22,2 mL na segunda sessão de escleroterapia. Uma terceira sessão de escleroterapia foi necessária em apenas 10 (13,2%) dos cistos. Na amostra geral, a taxa de regressão completa foi de 97,4%. O tempo médio de seguimento foi de 52,84 ± 37,83 meses. Conclusão: A ablação com etanol em intervalo de 24 horas é uma opção de tratamento segura, eficaz e minimamente invasiva no tratamento percutâneo de cistos renais simples.

A case of combined soft tissue and intraosseous venous malformation of the thumb treated with sclerotherapy using a bone marrow aspiration needle.

Vascular malformations of bone are complex lesions that can cause deformity and pain. A combined soft tissue and intraosseous venous malformation of the left thumb in a girl was treated with two sessions of ethanol sclerotherapy using a bone marrow aspiration needle under fluoroscopic guidance.

Intrauterine therapy for macrocystic congenital cystic adenomatoid malformation of the lung.

OBJECTIVE: To report on our experiences with thoracoamniotic shunting and/or the injection of a sclerosing agent (OK-432) to treat fetuses diagnosed with macrocystic congenital cystic adenomatoid malformation (CCAM) of the lung. METHODS: A retrospective study was undertaken in six fetuses with macrocystic CCAM at our institute that had been confirmed by postnatal surgery between August 1999 and January 2012. RESULTS: Six fetuses that had been diagnosed with macrocystic CCAM were analyzed. The median gestational age at diagnosis was 23.5 weeks (range, 19.5-31.0 weeks), and at the time of primary treatment was 24.0 weeks (range, 20.5-31.0 weeks). The mean size of the largest cyst at the initial assessment was 42.5±15 mm. Four fetuses were associated with mediastinal shifting, and one also showed fetal hydrops. All fetuses underwent a shunting procedure within the cysts, one case among them was also treated with OK-432. After the completion of all procedures, the mean size of the largest cyst was all decreased (14.2±12 mm). The median gestational age at delivery was 38.0 weeks (range, 32.4-40.3 weeks). All of the newborns underwent the surgical resection at a median age of 6 days (range, 1-136 days) and are currently doing well without any complications. CONCLUSION: We suggest that intrauterine decompression therapy to manage fetal macrocystic CCAM is recommendable treatment for good perinatal outcome.

Vascular sclerosing effects of bleomycin on cutaneous veins: a pharmacopathologic study on experimental animals

Abstract: Background: Varicose veins and the complications of venous disease are common disorders in humans. Objective: To study the effects of bleomycin as a potential new sclerosing agent and its adverse events in treating varicose veins. Methods: Bleomycin-loaded liposomes 0.1ml was injected in the dorsal ear veins of white New Zealand rabbits. Sodium tetradecyl sulfate was used as a positive control. Normal saline was used as negative control. The blood vessels of the treated ears were photographed before and at one hour and two, eight and 45 days after treatment. Biopsies from the treated areas were obtained for histological examination. Blood samples were collected to determine any possible toxicity. Results: Bleomycin by itself was ineffective; therefore, liposomes were used as a vector to deliver bleomycin to the vein lumen. Subsequently, bleomycin started showing its sclerosing effects. Toxicity monitoring showed no apparent hematologic, pulmonary, hepatic or renal toxicities. This study revealed that bleomycin induced vasculitis, which led to vascular occlusion, which was observed on day 1 and day 8. No bleomycin-related injury was noted by histopathological examination of lung sections. The calculation of the lung/body weight coefficient indicated that edema was present in the experimental groups compared with the negative and positive controls. Study limitations: Relatively small number of experimental animals used. Conclusions: This study showed that bleomycin-loaded liposomes were able to induce vasculitis and vascular occlusion without any toxicity or complications. It might be useful, hence, to treat patients suffering from Varicose veins and other ectatic vascular diseases with this agent.

Fístula arteriovenosa após escleroterapia com espuma guiada por ultrassom: relato de caso / Arteriovenous fistula after ultrasound guided foam sclerotherapy: case report

A escleroterapia com espuma guiada por ultrassom tem ganhado espaço no tratamento da insuficiência venosa crônica secundária a varizes dos membros inferiores. Trata-se de procedimento ambulatorial, de baixo custo e sem necessidade de afastamento das atividades habituais. Apresenta bons resultados clínicos, especialmente nos estágios mais avançados da doença. Quando bem aplicada, apresenta baixas taxas de complicações maiores. Porém, a técnica apresenta altas taxas de recanalização no médio e longo prazo, e seu mecanismo ainda não é totalmente compreendido. O presente artigo descreve um caso de fístula arteriovenosa em segmento de recanalização de veia safena magna, após escleroterapia com espuma guiada por ultrassom, e identificada por exame ultrassonográfico de vigilância pós-procedimento.

Ultrasound-guided foam sclerotherapy has become widespread in the treatment of chronic venous insufficiency secondary to varicose veins. It is a low-cost, outpatient procedure that does not require medical leave. It has demonstrated good clinical results, especially in the more advanced stages of the disease. When employed correctly, it results in low rates of major complications. However, the technique exhibits high recanalization rates over mid and long-term follow up. Additionally, the recanalization mechanism has not yet been explained. This article describes an arteriovenous fistula in a recanalized segment of great saphenous vein previously treated with ultrasound-guided foam sclerotherapy that was detected during post-procedure follow-up with ultrasound.

Evaluation of quality of life and photoplethysmography in patients with chronic venous insufficiency treated with foam sclerotherapy

BACKGROUND: Ultrasound-guided foam sclerotherapy plays a major role in treatment of chronic venous insufficiency, providing clinical and hemodynamic improvement to patients undergoing treatment.OBJECTIVES: To examine the relationships between venous refilling time and impact of venous disease on quality of life and between changes in venous refilling time and improvement of symptoms after ultrasound-guided foam sclerotherapy for chronic venous insufficiency. METHODS: Thirty-two patients classified as C4, C5 or C6 answered a questionnaire on quality of life and symptoms and their venous filling time was measured using photoplethysmography before and 45 days after treatment of chronic venous insufficiency with ultrasound-guided foam sclerotherapy.RESULTS: Statistically significant improvements were observed in quality of life scores and in venous filling time and in the following symptoms: aching, heavy legs, restless legs, swelling, burning sensations, and throbbing (p<0.0001). A similar improvement was also seen in the work and social domains of quality of life (p<0.0001).CONCLUSIONS: As confirmed by questionnaire scores and venous refilling times, ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels and low rates of major complications.

CONTEXTO: A escleroterapia com espuma guiada por ultrassom (EGUS) ocupa lugar de destaque no tratamento da insuficiência venosa crônica (IVC), proporcionando melhora clínica e hemodinâmica aos pacientes submetidos ao tratamento.OBJETIVOS: Verificar a correlação entre dados obtidos por questionário de qualidade de vida e de sintomas com dados obtidos por fotopletismografia (FPG), antes e depois do tratamento por escleroterapia com espuma guiada por ultrassom (EGUS) da insuficiência venosa crônica (IVC). MÉTODOS: Um grupo de 32 pacientes, classificados como C4, C5 e C6, foi submetido à aplicação de questionário de qualidade de vida e sintomas, sendo aferido o tempo de enchimento venoso (TEV) por FPG antes e 45 dias depois do tratamento da IVC através de EGUS. O teste do sinal foi utilizado para análise estatística da melhora dos escores dos questionários e do TEV. O teste de McNemar foi utilizado para avaliação da melhora nos sintomas e do impacto do tratamento nas atividades laborais e sociais dos pacientes.RESULTADOS: Houve melhora nos escores dos questionários de qualidade de vida e no TEV, com significância estatística (p<0,0001). Houve melhora estatisticamente significativa nos sintomas: dor, cansaço, edema, queimação, pernas inquietas e latejamento (p<0,0001). Incremento na qualidade laboral e social após o tratamento apresentou melhora estatisticamente significativa (p<0,0001). Não ocorreram complicações maiores ou efeitos adversos nesta série.CONCLUSÕES: A EGUS mostrou-se eficaz, com alto índice de satisfação e baixas taxas de complicacões maiores, ratificada pelos escores dos questionários e pelos TEVs aferidos pela FPG.

Esclerosis de hemorroides / Hemorrhoids Sclerosis

Introducción: las hemorroides son el prolapso de las estructuras del canal anal: epitelio, submucosa con sus estructuras vasculares y nerviosas. Objetivo: demostrar que la esclerosis de hemorroides grados I, II, III, IV es un método efectivo y comparar el costo de la técnica quirúrgica para la demostración del ahorro de recursos con el primero. Material y método: se realiza estudio clínico y endoscópico de todos los pacientes de ambos sexos que fueron atendidos en la consulta de Gastroenterología con el diagnóstico de portadores del síndrome hemorroidal basado en el método esclerosante (N=1086). Se añadirá el estudio del costo del método esclerosante para comparar con el otro de la técnica quirúrgica y demostrar el ahorro de recursos con el primero. Se utilizó el método estadístico ji cuadrado. Resultados: la esclerosis de hemorroides de todos los grados, es un método seguro y eficaz. Su posibilidad de realización ambulatoria por esta técnica ofrece grandes ventajas sociales y económicas para el paciente y la institución según un sencillo estudio comparativo de costo de ambas conductas terapéuticas. Conclusiones: la evolución fue satisfactoria en todos los casos con independencia del grado de las hemorroides, la realización ambulatoria de esta técnica ofrece grandes ventajas sociales y económicas tanto para el paciente como para las instituciones médicas que redundaría al aporte económico, sustitución de importaciones, consumo de medicamentos y materiales.

Introduction: hemorrhoids are prolapsed anal canal structures: epithelium, submucosa with vascular and nerve structures. Objective: to demonstrate that the sclerosis hemorrhoid grades I, II, III, IV is an effective method and compare the cost of the surgical technique for the demonstration of the resource savings to the first. Methods: clinical and endoscopic study of all patients of both sexes who were seen in consultation with the diagnosis of Gastroenterology carriers hemorrhoidal sclerosis syndrome(N = 1086). The study of the cost of sclerosing method is added to compare with the other surgical technique and demonstrate resource savings with the first. The chi-square statistical method was used. Results: sclerosis of all grades of hemorrhoids is a safe and effective method. Ambulatory performance by this technique offers great social and economic benefits for the patient and the institution as a simple comparative study of cost both therapeutic behaviors. Conclusions: the outcome was satisfactory in all cases regardless of the degree of hemorrhoids, outpatient performing this technique offers great social and economic benefits for both the patient and medical institutions that would lead to economic support, import substitution, consumption of medicines and materials.

Ethanol sclerotherapy of head and neck venous malformations / Escleroterapia com etanol em malformações venosas da cabeça e pescoço

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. .

Objetivo Estudo retrospectivo que analisou os resultados da escleroterapia, com doses baixas de etanol, realizada sob anestesia local para tratamento de malformações venosas na cabeça e pescoço. Métodos Foram tratados 51 pacientes, sendo 37 do gênero feminino. A mediana de idade foi de 23 anos. Os pacientes foram tratados com injeções alcoólicas nas lesões, por via percutânea, em sessões quinzenais, e acompanhados prospectivamente por um período mediano de 18 meses. A maioria das lesões acometia a face e a queixa principal mais frequente foi deformidade estética. Resultados Foram realizadas, em média, sete sessões de escleroterapia. Resolução completa ou melhora foi observada em 48 pacientes. Cinco pacientes apresentaram pequena úlcera cutânea, dois hiperpigmentação e dois parestesia, sendo todos tratados conservadoramente. Conclusão A escleroterapia percutânea com doses baixas de etanol é um método seguro e eficaz para tratar malformações venosas na cabeça e pescoço. .

Síndrome de Klippel-Trenaunay-Weber: associação do tratamento operatório à escleroterapia por espuma / Klippel-Trenaunay-Weber syndrome: association of operative treatment with foam sclerotherapy

A Síndrome de Klippel-Trenaunay-Weber representa a associação de hemangiomas planos, ectasias venosas e hipertrofia do segmento corpóreo afetado. Apresenta-se o caso de um paciente de 39 anos, sexo masculino, seguido desde 1993 no serviço da Disciplina de Cirurgia Vascular da Escola Paulista de Medicina (Unifesp), por quadro inicial da síndrome em membro inferior esquerdo. O paciente foi tratado apenas por elastocompressão e medidas gerais. Neste período, ele evoluiu com piora da estase venosa, da hipertrofia óssea e da hiperpigmentação de pele. Na ultrassonografia Doppler colorida venosa dos membros inferiores havia perviedade do sistema venoso profundo, hiperfluxo venoso, insuficiência segmentar de veia safena magna com sinais de tromboflebite e tributárias insuficientes. Indicou-se, para a melhora da estase venosa, ligadura da junção safeno-femoral esquerda e escleroterapia (polidocanol 3 por cento) retrógrada da mesma, com exérese das ectasias venosas. O paciente recebeu alta hospitalar no primeiro dia pós-operatório e atualmente está em acompanhamento ambulatorial com melhora significativa dos sintomas.

The Klippel-Trenaunay-Weber Syndrome is the association of hemangioma, venous ectasia, and hypertrophy of the affected body segment. We report the case of a 39-year-old male followed-up since 1993 due to onset of symptoms in the left lower limb. He was treated only with the use of elastic stockings and general measures. Over the years, he had worsening of venous stasis, of bone hypertrophy, and of skin hyperpigmentation. Color-coded Doppler ultrasonography of the lower limbs showed patency of the deep venous system, venous overflow, segmentar insufficiency of the greater saphenous vein with signs of thrombophlebitis, and insufficient tributary veins. In order to improve venous stasis, ligation of the left sapheno-femoral junction and retrograde foam sclerotherapy (polidocanol 3 percent) with resection of tributary veins were performed. The patient was discharged in the first postoperative day and has been followed as an outpatient, presenting significant improvement of the symptoms.