Treatment pattern of consecutive patients with chronic venous disease.

BACKGROUND: No clear data exist on the treatment patterns in patients with chronic venous disease. This study was designed to determine how such patients were treated in our center. METHODS: Consecutive patients presenting for a vein consultation at our center were collected during a 9-month period, allotting for at least 6 months of follow-up. All patients had a detailed history and physical examination by experienced vascular surgeons and a complete venous ultrasound evaluation by registered vascular technologists having experience in venous imaging. Charts were reviewed for patient factors including body mass index, age, clinical class (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification), and treatment. Deidentified data from the chart review were entered into a local database. Queries were designed to identify trends in the data. The results of the queries were exported to a spreadsheet program for analysis per patient and per limb. RESULTS: There were 506 patients evaluated for venous disease during a period of 9 months. We identified 200 patients with chronic venous disease who required superficial vein treatment. There were 136 (68%) women. Ablation was required in 156 patients (78%), whereas 44 (22%) required only adjunctive therapy (microphlebectomy or sclerotherapy). The average number of ablations in patients with venous disease was 1.3 (259 ablations in 200 patients). In patients who needed at least one ablation, the average was 1.7 ablations per patient (259 ablations in 156 patients). Unilateral ablation was done in 94 patients (60%), and 62 patients (40%) had bilateral treatment. Of those who underwent unilateral ablations, 61% required adjunctive treatment of the contralateral limb. In patients who required only adjunctive therapy (no ablation), 73% underwent bilateral treatment. There were 182 limbs (45.5%) that did not require ablation as no reflux was found in the saphenous systems. Of the 156 patients who underwent ablation, 218 limbs had at least one ablation; 52% of limbs had C2 disease and on average underwent 1.1 ablations/limb. Only 7 of 113 (6%) limbs required more than one ablation. Average ablations per limb increased with clinical class, C3 having 1.2 ablations/limb, C4 having 1.4 ablations/limb, and C5 and C6 having 1.56 ablations/limb. CONCLUSIONS: Patients with venous disease required on average 1.3 ablations/patient. Most (78%) require at least one ablation for an average of 1.7 ablations/patient. There were 182 limbs (45.5%) with no saphenous reflux that did not require an ablation. The average number of ablations/limb increased with CEAP class.

An update on the currently available nonthermal ablative options in the management of superficial venous disease.

BACKGROUND: Chronic venous insufficiency affects millions of Americans with symptoms spanning a broad range. Saphenous incompetence resulting in chronic reflux is at the root of most disease and is amenable to surgical correction. METHODS: We conducted a systematic review of the literature on nonthermal ablative techniques using a MEDLINE (Ovid) search from January 2000 to August 2016. Only prospective studies and literature review articles in the English language were included for final analysis. RESULTS: A total of 358 unique articles were identified, with a total of 60 articles meeting the stated inclusion and exclusion criteria. Historically, nonthermal ablative techniques have not demonstrated clinical results on par with thermal ablative interventions. However, three newer nonthermal ablative techniques have become available for use in the United States. Review of the literature demonstrated significant improvements in nonthermal ablative results, with intermediate-term data suggesting improved durability. CONCLUSIONS: Advances in nonthermal ablative techniques have led to a developing role and acceptance in the primary management of varicose veins and venous insufficiency, even in the setting of challenging cases.

The Impact of Race on Advanced Chronic Venous Insufficiency.

BACKGROUND: The study aimed to determine the association between race and patient variables, hospital covariates, and outcomes in patients presenting with advanced chronic venous insufficiency. METHODS: The National Inpatient Sample was queried to identify all Caucasian and African-American patients with a primary International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for venous stasis with ulceration (454.0), inflammation (454.1), or complications (454.2) from 1998 to 2011. CEAP scores were correlated with ICD-9 diagnosis. Demographics, CEAP classification, management, cost of care, length of stay (LOS), and inpatient mortality were compared between races. Statistical analysis was via descriptive statistics, Student's t-test, and the Fisher's exact test. Trend analysis was completed using the Mann-Kendall test. RESULTS: A total of 20,648 patients were identified of which 85% were Caucasian and 15% were African-American. Debridement procedures had the highest costs at $6,096 followed by skin grafting at $4,089. There was an overall decrease in the number of ulcer debridements, vein stripping, and sclerotherapy procedures between 1998 and 2011 (P < 0.05) for both groups. However, African-American patients had significantly more ulcer debridements than their Caucasian counterparts. CONCLUSIONS: African-American patients with a primary diagnosis of venous stasis present with more advanced venous disease at a younger age compared with their Caucasian counterparts. This is associated with increased ulcer debridement, deep vein thrombosis rates and hospital charges in the African-American cohort. There are no differences in sclerotherapy or skin grafting procedures, LOS or inpatient mortality between races.

Emerging endoscopic therapies for nonvariceal upper gastrointestinal bleeding.

Several new devices and innovative adaptations of existing modalities have emerged as primary, adjunctive, or rescue therapy in endoscopic hemostasis of gastrointestinal hemorrhage. These techniques include over-the-scope clip devices, hemostatic sprays, cryotherapy, radiofrequency ablation, endoscopic suturing, and endoscopic ultrasound-guided angiotherapy. This review highlights the technical aspects and clinical applications of these devices in the context of nonvariceal upper gastrointestinal bleeding.

The horizon for treating cutaneous vascular lesions.

Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.

Sclerotherapy: it is back and better.

With the recent US Food and Drug Administration (FDA) approval of polidocanol in the United States, there has been a resurgence of interest in sclerotherapy. Despite the popularity of laser therapy, sclerotherapy remains the gold standard for treating spider and reticular veins. Although this traditional method of treatment has been around for more than 100 years, better sclerosing agents and newer techniques have made sclerotherapy safer and more efficacious than ever before. This article is a primer for physicians interested in updating their skills in sclerotherapy. It reviews common sclerosants, sclerotherapy techniques, patient evaluation, complications, and recent advancements in sclerotherapy.

[Giant retinal tear detachment]. / Riesenrissamotio.

Giant retinal tears with possible tear inversion are a special group of rhegmatogenous retinal detachments. A good knowledge of the pathogenesis and surgical specifics is very important for the retinal surgeon to achieve the best anatomic results with a low PVR rate. The technical progress that was made since the 1960 s obviously led to better results in the therapy for giant retinal tears. To avoid a giant retinal tear of the second eye, a prophylactic treatment has to be discussed with the patient.

Trends in varicose vein therapy in England: radical changes in the last decade.

INTRODUCTION: We aimed to analyse national trends in varicose vein treatment in the UK National Health Service (NHS). SUBJECTS AND METHODS: The National Hospital Episode Statistics website (www.Hesonline.nhs.uk) was interrogated for patients treated (1998-2008) in the NHS for varicose veins. RESULTS: There has been a 34% decline in patients presenting for an intervention for varicose veins. For surgical procedures alone, the waiting times have fallen by 59%. In 2007-2008, 30,663 (72%) fewer bed days were used in comparison to 1998; accompanied by a 49% decline in the number of patients undergoing surgery. After a 47% decrease between 1998 and 2001, the number of patients requesting sclerotherapy treatment has increased by a substantial 311% over the subsequent 7 years. Transluminal procedures were used almost twice as often in 2007-2008 as in 2006-2007. CONCLUSIONS: There has been a steady decline in the number of patients treated for varicose veins. Fewer patients are undergoing surgery but are being managed more efficiently, with an increase in day cases and a reduction in total bed days. The demand for minimally invasive procedures has increased substantially. These trends will be of great importance for the future planning of vascular surgical services.

Current management of venous ulcers: an evidence-based review.

Chronic venous ulceration is a common and important medical problem that causes significant morbidity. Venous ulcers are expensive to treat, have substantial economic effects in terms of days of work lost, and adversely impact the patient's quality of life. Relying on evidence allows for a rationale of clinical decision making. The objectives of venous ulcer management include the healing of the ulcer, prevention of recurrence, and improvement of edema. Compression is the cornerstone of venous ulcer therapy. Adjunctive modalities such as surgery, growth factors, grafting, biologic skin substitutes, dressings, and oral medication have differing levels of evidence supporting their use, and may also facilitate the healing process.

Tratamiento percutáneo de las malformaciones vasculares periféricas con una mezcla de polidocanol y CO2. Experiencia inicial / Percutaneous treatment of peripheral vascular malformations with a mixture of polidocanol and CO2. Initial experience

Objetivo. El tratamiento percutáneo de las malformaciones vasculares periféricas es hoy día aceptado como primera opción terapéutica en estos procesos. Describimos nuestra experiencia inicial con una mezcla de polidocanol y CO2 como agente embolizante, analizando su eficacia y complicaciones. Material y métodos. Entre abril de 2005 y diciembre de 2006 se han tratado 18 pacientes, 11 mujeres (61%) y 7 hom bres (39%) con edades comprendidas entre 11 y 80 años. Una malformación vascular era hemodinámicamente activa (5%) y 17 eran hemodinámicamente inactivas (95%). Se realizaron en total 56 embolizaciones (rango: 1-7; media: 3) con una mezcla de polidocanol y CO2 (rango: 1-28 cm3; media 8 cm3). Las malformaciones se estudiaron con ecografía-Doppler, resonancia magnética y angiografía por punción directa o arteriografía. En función de la localización, tamaño y características hemodinámicas, se realizaron abordajes y tratamientos específicos para cada caso. Resultados. Se obtuvo un éxito técnico, entendiendo como tal la posibilidad de embolizar la malformación en el 100% de los casos. No se produjeron complicaciones técnicas. El período medio de seguimiento fue de 9 meses (rango: 1-20). Todos los pacientes, excepto una que rechazó continuar con el tratamiento, mejoraron objetiva y subjetivamente, y todos recuperaron las actividades diarias normales. Todos los pacientes presentaron edema, dolor e incremento de su impotencia funcional tras la embolización, que cedieron con tratamiento médico. Conclusión. La embolización percutánea de malformaciones vasculares con una mezcla de polidocanol y CO2 es un método eficaz y con baja incidencia de complicaciones. Nuestros resultados iniciales son esperanzadores, aunque se precisan estudios más extensos para extraer conclusiones definitivas (AU)

Objective. The percutaneous treatment of peripheral vascular malformations is currently the first treatment option for these processes. We describe our initial experience using a mixture of polidocanol and CO2 as an embolizing agent; we analyze the efficacy and complications of the treatment. Material and methods. Between April 2005 and December 2006, we treated a total of 18 patients, comprising 11 women (61%) and 7 men (39%), with ages ranging from 11 to 80 years. One (5%) vascular malformation was hemodynamically active and the remaining 17 (95%) were hemodynamically inactive. We performed a total of 56 embolizations (mean per patient, 3; range, 1-7) using a mixture of polidocanol and CO2 (mean, 8 cm3; range, 1-28 cm3). The malformations were studied with Doppler ultrasonography, magnetic resonance imaging, and direct puncture angiography and/or arteriography. Specific approaches and treatments were used in each case in function of the location, size, and characteristics of the malformation. Results. Technical success, defined as the possibility of embolizing the malformation, was achieved in all cases. No technical complications occurred. The mean follow-up period was 9 months (range, 1-20). All patients, except one woman who refused to continue treatment, improved objectively and subjectively, and all were able to return to normal daily activities. After embolization, all patients presented edema, pain, and increased functional incapacity that ceased with medical treatment. Conclusion. Percutaneous embolization of vascular malformations using a mixture of polidocanol and CO2 is efficacious and has a low rate of complications. Our initial results are promising but larger studies are necessary to reach definitive conclusions (AU)

Quiste de paratiroides recurrente. A propósito de un caso / Recurrent parathyroid cyst. A clinical case

El quiste paratiroideo es una entidad infrecuente, tanto que solamente unos 200 casos han sido descritos. Puede ser funcional y no funcional. Los estudios de imagen no nos aclaran si la procedencia es paratiroidea o de otro origen y el diagnóstico se establece con el análisis del líquido extraído en la punción aspiración, donde se aprecian altas concentraciones de PTH. El tratamiento es la cirugía en los funcional y la punción aspirativa en los no funcionales, que suelen solucionarse con una sola o a veces en otra repetida, dejándose para la cirugía los pocos recurrentes. Presentamos el caso de comportamiento recurrente y su evolución natural, donde la paciente rechaza la cirugía, siendo necesarias punciones repetidas. Después de 10 años no se ha malignizado ni cambiado su estado funcional, siendo necesario realizar repetidas punciones aspirativas cada 2-3 meses por molestias locales

The parathyroid cyst is a very infrequent entity, so much so that only round about 200 cases have been described up to now. It can be functional and non-functional. The studies of image don’t clarify to us if procedence becomes of parathyroid or it has another origin, and the diagnosisis made with the analysis come from the liquid obtained in the puncture aspiration, where high PTH’s concentrations are seen. Surgery is the treatment for functional cysts and the puncture aspiration for non- functional, the fact that they use to get solved with only one but sometimes is necessary to repeated it, even more than one time, keeping for the surgery when recurrent. We presented a clinical case of recurrent parathyroidcyst and his natural evolution, due to patient rejects surgery, being necessary repeated punctures. It hasn’t become malignant after 10 years and his functional status wasn’t changed, being necessary to accomplish repeated punctures aspirations each 2-3 months for local bothers

Foam sclerotherapy--a possible option in therapy of varicose veins.

The therapy of varicose veins is multimodal and depends on the individual clinical findings. In addition to compression therapy, invasive approaches for elimination of reflux for the treatment of varicose veins are available, such as surgical and interventional methods and sclerotherapy. The administration of a sclerosing agent into a varicose vein results in an occlusion of the treated vein. Recently the use of foam sclerotherapy had a renaissance. Several studies have documented the efficacy of foam sclerotherapy in selected patients. The possibility of treating patients in an outpatient setting, with low costs and rapidly, makes foam sclerotherapy very attractive compared to invasive and minimally invasive methods. However long-term follow-ups in properly controlled randomized trials are needed before foam sclerotherapy can be recommended as a routine procedure. This paper introduces the method and the treatment possibilities with foam sclerotherapy in chronic venous insufficiency.

New methods for the management of esophageal varices.

Bleeding from esophageal varices (EVs) is a catastrophic complication of chronic liver disease. Many years ago, surgical procedures such as esophageal transection or distal splenorenal shunting were the only treatments for EVs. In the 1970s, interventional radiology procedures such as transportal obliteration, left gastric artery embolization, and partial splenic artery embolization were introduced, improving the survival of patients with bleeding EVs. In the 1980s, endoscopic treatment, endoscopic injection sclerotherapy (EIS), and endoscopic variceal ligation (EVL), further contributed to improved survival. We combined IVR with endoscopic treatment or EIS with EVL. Most patients with EVs treated endoscopically required follow-up treatment for recurrent varices. Proper management of recurrent EVs can significantly improve patients' quality of life. Recently, we have performed EVL at 2-mo (bi-monthly) intervals for the management of EVs. Longer intervals between treatment sessions resulted in a higher rate of total eradication and lower rates of recurrence and additional treatment.

Cirugía clásica frente a 3-S safenectomía para el tratamiento de las varices del miembro inferior / Classical surgery versus 3-S saphenectomy in the treatment of lower extremity varices

Introducción. Se estima que aproximadamente entre un 20 y un 30% de las varices operadas necesitarán ser reintervenidas. A lo largo de estos años, se han diseñado diferentes técnicas con la pretensión de reducir la elevada tasa de recidivas que se produce tras el clásico stripping, y de modo especial la recidiva del tipo reticular que se genera en la unión safenofemoral. El objetivo de este estudio es comparar la tasa de recidiva de las varices operadas con dos opciones técnicas: la safenectomía clásica y la 3-S safenectomía. Pacientes y método. Se distribuyó a 100 pacientes con varices de la extremidad inferior de forma aleatoria en 2 grupos: grupo I: 50 pacientes sometidos a cirugía clásica (ligadura y sección en la unión safenofemoral y venas colaterales, más safenectomía); grupo II: 50 pacientes sometidos a la técnica 3-S safenectomía (esclerosis del cayado con esclerosante en forma de espuma a través de un catéter, safenectomía más flebectomías del segmento distal). A los 12 meses de la intervención, se evaluó a los pacientes mediante eco-Doppler para determinar la tasa y el tipo de recidiva en cada técnica. Resultados. La recidiva global fue: grupo I: 78% y grupo II: 44% (p < 0,05). La recidiva troncular fue en el grupo I del 12% y en el grupo II del 16% (p = NS). La recidiva colateral fue en el grupo I del 16% y en el grupo II del 6% (p = NS). La recidiva de la vena perforante fue en el grupo I del 18% y en el grupo II del 18% (p = NS). La recidiva tipo variz reticular fue en el grupo I del 32% y en el grupo II del 4% (p = 0,002). Conclusiones. La técnica 3-S safenectomía disminuye la tasa global de recidivas, y especialmente las de tipo reticular. Se aconseja evitar el abordaje quirúrgico de las ramas colaterales del cayado de la vena safena (AU)

Introduction. The rate of recurrence requiring redo surgery after primary surgical treatment of varicose veins is between 20 and 30%. Several techniques to reduce the high rate of recurrence after stripping have been designed over the years, especially reticulated recurrences at the sapheno-femoral junction. The aim of this study was to compare the recurrence rates of varices after treatment with two surgical techniques: stripping and 3-S saphenectomy. Patients and method. One hundred patients with leg varicose veins were randomly assigned to two groups. Group I consisted of 50 patients who underwent classical surgery (ligature and section at the sapheno-femoral junction and collateral veins, with saphenectomy). Group II consisted of 50 patients who underwent the 3-S saphenectomy technique (sclerosis injection at the sapheno-femoral junction with microfoam through a catheter, with saphenectomy and distal phlebectomies). The rate and type of recurrences were evaluated through echo-Doppler 12 months after the procedure. Results. Overall recurrence: group I: 78%, group II: 44% (P<.05). Trunk recurrence: group I 12%, group II 16% (P=NS). Collateral recurrence: group I 16%, group II 6% (P=NS). Perforator vein recurrence: group I 18%, group II 18% (P=NS). Reticulated recurrence: group I 32%, group II 4% (P=.002). Conclusions. The 3-S saphenectomy technique decreases the overall rate of recurrence, particularly reticulated type recurrences. We recommend avoidance of surgery of the branches at the sapheno-femoral junction (AU)

Malformaciones venosas. Importancia de su diagnóstico y tratamiento en la infancia / Venous malformations. Diagnosis and treatment during the childhood

Introducción. La malformación venosa congénita (MVC) es la anomalía vascular de bajo flujo más frecuente en la infancia, aunque en muchas ocasiones no puede evidenciarse al nacimiento y se hace clínicamente más llamativa en edades tardías. Característicamente no involuciona sino que manifiesta un desarrollo progresivo y variable a lo largo del tiempo. Pacientes y métodos. Realizamos un estudio retrospectivo de la historia clínica de 72 pacientes diagnosticados y tratados de MVC en nuestro Servicio en los últimos 15 años. La edad de los pacientes oscilaba entre los 5 días y los 26 años, con una proporción de mujeres de 2 sobre uno. La localización más frecuente de las malformaciones fue en las extremidades seguida de las que asentaban en cabeza y cuello. No se incluyeron en el estudio aquellos pacientes que tenían lesiones mixtas y en el SNC. Resultados. Los síntomas fueron, por orden de frecuencia, el dolor (60% de los pacientes), la tromboflebitis, el aumento de tamaño de la extremidad, los fenómenos dérmicos, la distrofia ósea y, en último término, la coagulopatía de consumo. En prácticamente todos los enfermos la sintomatología se desencadenó o se intensificó en relación a traumatismos, infecciones y cambios hormonales. El diagnóstico se realizó mediante valoración clínica, ecoDoppler en todos los pacientes para descartar alto flujo y RN como estudio de extensión. No se realizó arteriografía de rutina y en algunos casos se (..) (AU)

Introduction. Congenital venous malformations are the most common slow-flow vascular abnormalities during childhood. Although they are usually present at birth, clinical evidence often appear during late childhood. This type of malformations do not disappear, and they grow progressively during years. Patients and methods. We present a retrospective study based on the medical records of 72 patients treated in our Department during the last 15 years. Patients` age at the diagnosis was 5 days to 26 years. Malefemale relationship was 2:1. The most frequent locations were Upper and lower extremities, followed by head and neck. We do not include in this study those patients with mixed lesions involving CNS or abdomen. Results. Main symptoms were: pain, 60%; thrombophlebitis, growing size of the extremities, dermis lesions, osseous dystrophy and chronic coagulopathy. Symptoms worsening was related to trauma, infections and hormonal changes. Clinical course was the clue for the diagnosis. Eco-doppler was useful to study the flow of the lesion. MRI was employed to determinate the limits of the lesion. We did not perform arteriography, and phlebography was used as a diagnostic and therapeutic tool. Plain X-rays showed phleboliths in most of patients and osseous changes in a group of six patients. Treatment was conservative and palliative using elastic stockings, pain therapy and thromboembolism prophylaxis This was the only treatment in irresectable lesions and in those cases without functional abnormalities. Surgery and sclerotherapy were the main curative treatments. Sclerotherapy was employed in cases of intramuscular and in delimited lesions. Ethanol and Ethibloc (Sodic Amidotrozoate) were the sclerosant agents. We performed surgery in cases of cutaneous complications, localized muscular lesions and in cases of recurrences after sclerotherapy. Ablative surgery was followed by reconstructive attempts using cutaneous and dermal artificial grafts. Conclussions. Congenital venous malformations must be diagnosed and treated during childhood. Conservative and resective treatments are useful in different cases. Accurate diagnosis and treatment improve long term results (AU)

[Modern aspects of varicose vein surgery]. / Moderne Aspekte der Phlebochirurgie.

In Germany almost every third adult suffers from varicose veins requiring treatment. Conventional varicose vein surgery by high ligation and stripping is widely accepted as standard therapy for saphenous vein insufficiency, although associated with a high frequency of recurrent varicosities. Innovative endovascular procedures laying claim to be minimally invasive have been implemented over the last five years: endovenous radiofrequency obliteration, endovenous laser treatment and ultrasound-guided sclerotherapy with foam. The early treatment outcomes are promising in regard to recurrent varicose veins, cosmetic results and convalescence. Evidence-based prospective trials with large numbers of participants comparing the interventional procedures with high ligation and stripping are still missing. This report delineates current developments in varicose vein surgery and provides information on principles, effectiveness and side effect profiles of endovascular therapy procedures.

Escleroterapia percutánea de linfoceles con povidona yodada / Percutaneous sclerotherapy of a lymphocele with povidone iodine

Objetivo: Evaluar la efectividad de la esclerosis percutánea de linfoceles con povidona yodada.Material y Métodos: Estudio retrospectivo de ocho pacientes con una edad media de 49 años a los que se les ha realizado una esclerosis percutánea de linfoceles con povidona yodada. Seis linfoceles aparecieron tras trasplante renal, un linfocele tras intervención por adenocarcinoma de endometrio y otro linfocele tras trasplante de pulmón que requirió múltiples cateterismos femorales.Tras colocar un catéter pig-tail 8F en la colección se aspiró todo el líquido posible enviando muestras a bioquímica, citología y bacteriología; tras confirmación de que el líquido aspirado era linfa se procedió a la instilación de povidona yodada introduciendo cada 12 horas la mitad del volumen aspirado inicialmente, dejándolo en el interior de la colección durante 30 minutos. El catéter se retiró tras evidencia ecográfica de desaparición de la colección. A todos los pacientes se realizó ecografía de seguimiento.Resultados: Todos los linfoceles fueron sintomáticos y estériles y aparecieron tras un tiempo medio de 125 días tras la cirugía. El tamaño medio inicial de los linfoceles fue de 10,6 × 8,1 cm y volumen medio inicial de linfa aspirada fue de 161 ml. El tiempo medio de permanencia del catéter fue de 17 días y no hubo sobreinfección de la colección.En seis pacientes se consiguió una esclerosis completa (sin posterior recidiva) tras un tiempo medio de seguimiento de 23 meses. En un paciente hubo una colección residual de 2 × 2 cm que ha permanecido estable y asintomática durante 11 meses. En una paciente con esclerosis inicial se produjo una colección recidivante de 12 × 4 cm a los ocho meses.Conclusión: La escleroterapia percutánea de linfoceles con povidona yodada es un tratamiento efectivo (AU)