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1.
Ann Vasc Surg ; 59: 231-236, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009711

RESUMO

BACKGROUND: The procedure aims to show our results with a novel nontumescent, nonthermal technique to treat varicose veins. The V-block occlusion stent is a minimally invasive device for treating reflux of the great saphenous vein (GSV). It is an office-based procedure that does not require tumescence anesthesia. The V-block stent is a self-expandable device that functions as a vein occluder and blood clot trap. Once the V-block is in place, further treatment of the saphenous vein such as ultrasound-guided sclerotherapy can be performed. The V-block device is intended to eliminate the possibility of forwarding passage of clot and sclerosant (embolization) to the deep and pulmonary circulations. METHODS: Patients were treated in an outpatient setting with the V-block occluding device. Follow-up was performed using duplex ultrasound to assess occlusion of the saphenous vein as well as the Aberdeen Varicose Vein Questionnaire and Venous Severity Scoring to determine changes in quality of life after the procedure. Patients were followed up at 1 week, 1 month, and 3 months after V-block placement. Duplex scanning was performed to confirm GSV occlusion at all follow-up visits. After deployment of the occlusion stent, a maximum of 2% polidocanol foam was injected with a double barrel syringe which simultaneously evacuated blood from the greater saphenous vein. Follow-up assessment for safety included evaluation of potential complications, device migration, and potential injury at the deployment site. RESULTS: Fifty-one symptomatic subjects with documented GSV reflux were enrolled in the study. Complete occlusion of the GSV was achieved in 98% of the patients during the 7-day postprocedural visit. There was no injury at the deployment site. No migration of the V-block device was observed. No deep vein thrombosis or any other complication was recorded. One patient of the 50 patients and 51 procedures experienced an adverse event, phlebitis that resolved under conservative therapy within 4 days with no residual effect. There was a significant improvement in the Aberdeen Vein quality of life measurements and the pain scores. After 3 years, 18 patients were willing to undergo a duplex follow-up examination. The occlusion rate after 3 years was 77.8. There were no device-related complications after this period. CONCLUSIONS: The study demonstrated a good safety and performance profile without any major adverse events. The primary end point of vein occlusion and obliteration was met.


Assuntos
Procedimentos Endovasculares/instrumentação , Polidocanol/administração & dosagem , Veia Safena , Soluções Esclerosantes/administração & dosagem , Escleroterapia/instrumentação , Stents , Varizes/terapia , Idoso , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol/efeitos adversos , Desenho de Prótese , Qualidade de Vida , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
2.
World Neurosurg ; 126: 423-427, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904804

RESUMO

BACKGROUND: Different treatment options have been proposed for aneurysmal bone cysts (ABCs) with sclerotherapy favored as primary treatment and surgery remaining the mainstay of treatment in case of compression of neural structures. Recurrent spinal ABCs are burdened by increased risk of spinal deformity and instability, further complicating the management of these cases. CASE DESCRIPTION: A 15-year-old boy presented with acute symptoms and signs of spinal cord compression due to a large thoracic ABC. Subtotal resection of the lesion achieved optimal decompression of neural structures with good neurologic recovery, but the remnant of the lesion rapidly grew with recurrent spinal cord compression after 40 days. The patient underwent total surgical resection with full neurologic recovery. Unfortunately, recurrence of the lesion was documented at 3-months' follow-up. This was successfully treated with percutaneous injection of hydroxyapatite cement. Two years' follow-up ruled out any further recurrence of the lesion. Furthermore, spinal deformity and instability were also excluded. CONCLUSIONS: Percutaneous sclerotherapy with hydroxyapatite cement proved to be highly effective and safe in the treatment of spinal ABC, though surgery remains mandatory in case of spinal cord compression. The main advantage of sclerotherapy with hydroxyapatite cement seems to be the capacity to regenerate bone with normal radiologic features.


Assuntos
Cistos Ósseos Aneurismáticos/terapia , Escleroterapia/métodos , Compressão da Medula Espinal/etiologia , Adolescente , Cistos Ósseos Aneurismáticos/complicações , Humanos , Hidroxiapatitas , Masculino , Recidiva , Escleroterapia/instrumentação , Prevenção Secundária/métodos , Resultado do Tratamento
3.
Angiol Sosud Khir ; 24(3): 92-97, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30321152

RESUMO

Compression serves as an important component for carrying out successful and safe phlebosclerosing treatment. At the same time, the necessity of wearing compression hosiery or bandages is associated with known limitations and objections of patients, especially in a hot season. We comparatively assessed efficacy of usual compression stockings and a short-term pneumatic bandage with cryoelements while carrying out sclerosing treatment of dilated intradermal veins. Our open prospective observational study included a total of fifty 18-to-35-year-old women. After performing standardized sclerotherapy of reticular veins and telangiectasias on the symmetrical portions of the lower limbs, a pneumatic cryocompression bandage with a pressure of 50 mmHg was applied onto one of the limbs for 15 minutes, with a class 2 compression (RAL standard) medical stocking put on the other limb to be worn by the patients at daytime for 10 days. We assessed completeness of obliteration of the target veins, frequency of the development of typical undesirable events (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as the composite discomfort score according to an 11-point visual analogue scale. It was determined that using the pneumatic bandage with cryoelements as compared with the traditional compression stockings significantly decreased the frequency of the development of typical undesirable events after phlebosclerosing treatment, such as formation of ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis. Significance of differences was revealed as early as 7 days after sclerotherapy, to be increasing during further dynamic follow up. By convenience for the patients, the use of the short-term pneumatic cryobandage was four times better than wearing the compression stockings. A conclusion was drawn that while carrying out sclerotherapy of reticular veins and telangiectasias short-term pneumatic cryocompression by efficacy and safety was not inferior to the traditional medical stockings (RAL standard) and made it possible to significantly decrease the incidence of the known undesirable events after phlebosclerosing treatment.


Assuntos
Crioterapia/métodos , Extremidade Inferior/irrigação sanguínea , Escleroterapia , Meias de Compressão , Telangiectasia/terapia , Varizes/terapia , Adulto , Pesquisa Comparativa da Efetividade , Feminino , Humanos , Projetos Piloto , Escleroterapia/instrumentação , Escleroterapia/métodos , Telangiectasia/diagnóstico , Varizes/diagnóstico , Escala Visual Analógica
4.
Radiology ; 289(3): 854-859, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30152743

RESUMO

Purpose To evaluate the effectiveness of catheter-directed sclerotherapy (CDS) with 95% ethanol in patients with primary or recurrent ovarian endometriomas. Materials and Methods In this prospective study, 14 participants (mean age, 32 years; range, 20-44 years) who underwent CDS for ovarian endometrioma from March 2015 to December 2017 were evaluated. Diagnosis was based on symptoms and imaging studies. To assess the impact of CDS on ovarian reserve, serum anti-Müllerian hormone (AMH) was measured before CDS and 6 months after CDS. Serum cancer antigen 125 (CA-125) levels were also measured at the same time points. Follow-up US was performed 1, 3, and 6 months after CDS and biannually thereafter to monitor potential cyst size change and recurrence. Comparison of AMH, CA-125, and cyst size before and after CDS was performed by using the paired t test or Wilcoxon signed-rank test. Results Mean endometrioma size decreased from 5.8 cm ± 2.2 to 1.1 cm ± 1 (P ˂ .001). During a mean follow-up of 12.7 months (range, 6.1-23.0 months), there were no recurrences of endometrioma. Pain was relieved in all participants, with a decrease in serum CA-125 level (P = .001). There was no difference in serum AMH level before and 6 months after CDS, indicating well-preserved ovarian function (4.29 ng/mL ± 2.47 vs 4.36 ng/mL ± 1.94, respectively; P > .875). There were no procedure-related complications. Conclusion Catheter-based sclerotherapy with 95% ethanol can lead to better short-term clinical outcomes and well-preserved ovarian function for patients with endometriomas. © RSNA, 2018.


Assuntos
Endometriose/terapia , Doenças Ovarianas/terapia , Escleroterapia/instrumentação , Escleroterapia/métodos , Adulto , Cateteres , Endometriose/diagnóstico por imagem , Etanol/administração & dosagem , Feminino , Fluoroscopia , Humanos , Masculino , Doenças Ovarianas/diagnóstico por imagem , Ovário/diagnóstico por imagem , Estudos Prospectivos , Radiografia Intervencionista , Resultado do Tratamento , Adulto Jovem
5.
Eur J Gastroenterol Hepatol ; 30(6): 626-630, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29505477

RESUMO

BACKGROUND AND AIM: Endoscopic treatment is widely accepted as the first-line therapy selection for esophageal variceal bleeding. Nevertheless, endoscopic injection sclerotherapy requires experienced endoscopists and is associated with a high risk of bleeding. Our study evaluates the feasibility and efficacy of transparent cap-assisted endoscopic sclerotherapy in the management of esophageal varices. PATIENTS AND METHODS: A randomized-controlled trial was conducted in a tertiary referral center from April 2015 to May 2016. Patients who received endoscopic sclerotherapy were randomized in a blinded manner into two groups: the transparent cap-assisted group (n=59) and the control group (n=61). RESULTS: The average injection sites were reduced in the transparent cap-assisted group compared with the control group (1.2±0.4 vs. 1.4±0.05, P=0.000), whereas no difference was observed in the dosage of lauromacrogol (16.97±4.91 vs. 16.85±4.57, P=0.662) and the hemorrhage that occurred during injection made no difference (50.8 vs. 61.0%, P=0.276); yet, salvage hemostasis methods were used in only nine patients in the transparent cap-assisted group compared with 17 patients in the control group (25.0 vs. 38.7%, P=0.0936). The cost of each procedure in the cap-assisted group was ¥2578 (1878-4202), whereas it was ¥3691 for the control group (2506-5791) (P=0.023). Moreover, in both groups, no esophageal constriction was observed during the 6-month follow-up period, whereas the rebleeding rate between two groups showed no statistical significance in 6 months (89.8 vs. 93.4%, P=0.563). CONCLUSION: Transparent cap-assisted sclerotherapy provided a clear field of vision and helped to fix the targeted veins, thus significantly reducing the use of the salvage hemostasis method during sclerotherapy injection hemorrhage. It is also associated with reduced injection sites and endoscopic therapy cost.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Esofagoscópios , Esofagoscopia/instrumentação , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/instrumentação , Polietilenoglicóis/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Escleroterapia/instrumentação , China , Análise Custo-Benefício , Desenho de Equipamento , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/economia , Esofagoscópios/economia , Esofagoscopia/efeitos adversos , Esofagoscopia/economia , Estudos de Viabilidade , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/economia , Custos de Cuidados de Saúde , Hemostase Endoscópica/efeitos adversos , Hemostase Endoscópica/economia , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol , Polietilenoglicóis/efeitos adversos , Polietilenoglicóis/economia , Estudos Prospectivos , Recidiva , Soluções Esclerosantes/efeitos adversos , Soluções Esclerosantes/economia , Escleroterapia/efeitos adversos , Escleroterapia/economia , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
6.
Gastrointest Endosc ; 87(2): 360-369, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28694009

RESUMO

BACKGROUND AND AIMS: Dual red imaging (DRI) is a novel image-enhanced endoscopy technique that can increase the visibility and predict the depth of esophageal varices (EVs). The recurrence rate of EVs after endoscopic injection sclerotherapy (EIS) reportedly decreases by intravariceal injection of a sclerosant. We evaluated prospectively whether the EIS success rate was increased by DRI compared with the white-light imaging (WLI) mode. METHODS: A total of 79 patients with EVs were randomly divided into the DRI (n = 40) and WLI (n = 39) groups. The primary endpoint was the success rate of intravariceal injection on the first EIS puncture. The secondary endpoint was the recurrence rate. A variable puncture needle was used, and the length was adjusted according to the EV visibility change by DRI. In the WLI group, DRI was not used. RESULTS: The success rate of the first puncture was significantly higher in the DRI group than in the WLI group (80.0% vs 46.2%; P = .0018). The cumulative recurrence rate was significantly lower in the DRI group (P = .031). The sum of the depth and luminal diameter of EVs was investigated by EUS. The Pearson correlation coefficient between this value and the needle length was higher in the DRI group than in the WLI group (r = 0.878 vs 0.603). CONCLUSIONS: DRI increased the EIS success rate and decreased the recurrence rate. This resulted from the puncture needle adjustment to the appropriate length via EV depth prediction by DRI.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/terapia , Imagem Óptica/métodos , Escleroterapia , Idoso , Cor , Endoscopia Gastrointestinal , Endossonografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Estudos Prospectivos , Punções , Recidiva , Escleroterapia/instrumentação , Resultado do Tratamento
7.
Cardiovasc Intervent Radiol ; 41(2): 317-322, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29038875

RESUMO

PURPOSE: To report a sclerotherapy technique for rectal varices consisting of direct puncture of the superior rectal vein with a small-bore sheathed needle via the greater sciatic foramen without insertion of a sheath or catheter. MATERIALS AND METHODS: The subjects of this retrospective study were three consecutive patients who underwent embolization of rectal varices, two for rupture of rectal varices and one for hepatic encephalopathy and hyperammonemia. A 5% solution of ethanolamine oleate with iodinated contrast agent (5% EOI) was injected through puncture of the superior rectal vein and carried in the blood flow, after which n-butyl cyanoacrylate mixed with lipiodol (NBCA-Lip) was immediately injected to stop the blood flow. RESULTS: The 5% EOI and NBCA-Lip were successfully injected in all three patients. There was no movement of NBCA-Lip on plain radiographs or computed tomography (CT) immediately after injection, and the 5% EOI remained within the rectal varices. The mean procedure time was 53 min (42-60 min). On contrast-enhanced CT 1 month after the procedure, there was no contrast enhancement of the rectal varices that had been seen on preoperative CT in any of the three patients, confirming that the rectal varices had disappeared. CONCLUSION: Sclerotherapy for rectal varices using an approach for puncture of the superior rectal vein with a small-bore sheathed needle via the greater sciatic foramen was technically feasible and clinically effective.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Ácidos Oleicos/uso terapêutico , Doenças Retais/terapia , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Idoso , Meios de Contraste , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Feminino , Humanos , Agulhas , Punções , Radiografia , Doenças Retais/diagnóstico por imagem , Reto/irrigação sanguínea , Reto/diagnóstico por imagem , Estudos Retrospectivos , Escleroterapia/instrumentação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Dermatol Surg ; 44(5): 689-696, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29140865

RESUMO

BACKGROUND: Despite the popularity of sclerotherapy for treating varicose veins, it still exhibits various problems, such as pulmonary embolism, deep-vein thrombosis, phlebitis, and visual disorders. OBJECTIVE: To investigate syringe volume influence on foam stability, obtain the foam decay rule, and provide a reference for clinics. MATERIALS AND METHODS: Five types of syringes are used to prepare foam at room temperature with various liquid-gas ratios. Foam decay process experiments were performed 5 times and recorded by video. The stability indices used include drainage time, half-life, bubble diameter, bubble surface density, and drainage rate. RESULTS: The 30 and 2-mL syringes, respectively, recorded the highest and lowest drainage speeds. Foam drainage time and half-life, differences varied between 15 and 70 seconds, and 20 and 100 seconds, respectively. Foam bubble diameters were distributed over 0.1 to 2.0 mm with roughly 200 to 700 bubbles per square centimeter. CONCLUSION: Increased syringe volume causes the bubble diameter to increase. Thus, foam dispersion increases and foam half-life decreases; hence, foam becomes unstable. It is, thus, better to use a small syringe several times to prepare foam in clinics using segmented injections.


Assuntos
Soluções Esclerosantes/administração & dosagem , Escleroterapia/instrumentação , Morruato de Sódio/administração & dosagem , Seringas , Varizes/terapia , Estabilidade de Medicamentos , Meia-Vida , Humanos , Injeções , Modelos Químicos , Transição de Fase , Veia Safena/cirurgia , Escleroterapia/efeitos adversos , Temperatura Ambiente , Resultado do Tratamento
9.
World J Gastroenterol ; 23(44): 7875-7880, 2017 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-29209128

RESUMO

AIM: To investigate the efficacy and safety of a combination of sufentanil and propofol injection in patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs). METHODS: Patients with severe EVs who underwent EIS with sufentanil and propofol anesthesia between April 2016 and July 2016 at our hospital were reviewed. Although EIS and sequential therapy were performed under endotracheal intubation, we only evaluated the efficacy and safety of anesthesia for the first EIS procedure. Patients were intravenously treated with 0.5-1 µg/kg sufentanil. Anesthesia was induced with 1-2 mg/kg propofol and maintained using 2-5 mg/kg per hour of propofol. Information, regarding age, sex, weight, American Association of Anesthesiologists (ASA) physical status, Child-Turcotte-Pugh (CTP) classification, indications, preanesthetic problems, endoscopic procedure, successful completion of the procedure, anesthesia time, recovery time, and anesthetic agents, was recorded. Adverse events, including hypotension, hypertension, bradycardia, and hypoxia, were also noted. RESULTS: Propofol and sufentanil anesthesia was provided in 182 procedures involving 140 men and 42 women aged 56.1 ± 11.7 years (range, 25-83 years). The patients weighed 71.4 ± 10.7 kg (range, 45-95 kg) and had ASA physical status classifications of II (79 patients) or III (103 patients). Ninety-five patients had a CTP classification of A and 87 had a CTP classification of B. Intravenous anesthesia was successful in all cases. The mean anesthesia time was 33.1 ± 5.8 min. The mean recovery time was 12.3 ± 3.7 min. Hypotension occurred in two patients (1.1%, 2/182). No patient showed hypertension during the endoscopic therapy procedure. Bradycardia occurred in one patient (0.5%, 1/182), and hypoxia occurred in one patient (0.5%, 1/182). All complications were easily treated with no adverse sequelae. All endoscopic procedures were completed successfully. CONCLUSION: The combined use of propofol and sufentanil injection in endotracheal intubation-assisted EIS for EVs is effective and safe.


Assuntos
Anestesia/métodos , Anestésicos Intravenosos/efeitos adversos , Varizes Esofágicas e Gástricas/terapia , Complicações Pós-Operatórias/epidemiologia , Propofol/efeitos adversos , Escleroterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Esofagoscopia/efeitos adversos , Esofagoscopia/instrumentação , Esofagoscopia/métodos , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , Polidocanol , Polietilenoglicóis/administração & dosagem , Complicações Pós-Operatórias/etiologia , Propofol/administração & dosagem , Escleroterapia/instrumentação , Escleroterapia/métodos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
10.
J Vasc Surg Venous Lymphat Disord ; 5(3): 422-429, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28411711

RESUMO

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.


Assuntos
Técnicas de Ablação/métodos , Insuficiência Venosa/cirurgia , Técnicas de Ablação/instrumentação , Técnicas de Ablação/tendências , Doença Crônica , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Desenho de Equipamento , Humanos , Veia Safena/cirurgia , Escleroterapia/instrumentação , Escleroterapia/métodos , Escleroterapia/tendências , Técnicas de Fechamento de Ferimentos/instrumentação , Técnicas de Fechamento de Ferimentos/tendências
11.
J Vasc Surg Venous Lymphat Disord ; 5(1): 75-81.e1, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27987615

RESUMO

OBJECTIVE: The purpose of this study was to assess practice patterns of endovenous ablation therapy for the treatment of venous reflux disease among the vein specialist members of the American Venous Forum (AVF). METHODS: An online survey was conducted of AVF members designed to identify demographics, treatment practices, and clinical variables in the selection of vein ablation devices. RESULTS: The survey was distributed to 798 practicing physicians, of whom 129 (16%) responded. The specialty distribution of respondents was as follows: vascular surgeons, 54%; phlebologists, 14%; general surgeons, 11%; interventional radiologists, 9%; and other specialties, 6%. The majority (81%) were from the United States, and 65% were self-employed. Almost half (47%) were in practice for >20 years, with 33% of all respondents performing three to five saphenous vein ablations per week. Three-quarters (79%) of respondents preferred radiofrequency ablation (RFA), with 47% believing that it was more cost-effective and more than half (57%) reporting improved patient satisfaction with this technique. Most of them (63%) responded that previous capital investment played a significant role in their choice of vein ablation device along with the associated cost of disposable equipment. A large majority (77%) of physicians responded that they had a significant role in choosing the treatment device, whereas only 17% thought that patients' choice played a major role in device choice. The capital investment affected choice of modality more significantly in newer practices (P < .0.5). CONCLUSIONS: The majority of AVF vein specialists prefer an RFA technique to laser, believing that RFA is associated with improved patient outcomes and is more cost-effective. Advances in technology, device costs, and reimbursement levels may have an impact on such preferences in the future.


Assuntos
Técnicas de Ablação/métodos , Procedimentos Endovasculares/métodos , Padrões de Prática Médica/estatística & dados numéricos , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Técnicas de Ablação/instrumentação , Atitude do Pessoal de Saúde , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Tomada de Decisão Clínica , Análise Custo-Benefício , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/instrumentação , Custos de Cuidados de Saúde/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Satisfação do Paciente , Padrões de Prática Médica/economia , Veia Safena/cirurgia , Escleroterapia/economia , Escleroterapia/instrumentação , Escleroterapia/métodos , Estados Unidos
12.
J Cardiovasc Surg (Torino) ; 57(6): 750-757, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27647339

RESUMO

Percutaneous, catheter-directed embolotherapy is an established interventional technique for the management of many vascular disorders. For more than three decades, typical embolization devices included macro and microcoils, polyvinyl alcohol microparticles, glue and certain liquids such as absolute alcohol. In the past decade, however, several new embolic devices and refinements of existing embolic devices have arrived on the market and a number of clinical studies have demonstrated their added value. In this review article, these new embolic devices and their typical indications will be discussed, as well as the results of studies involving the embolic devices.


Assuntos
Embolização Terapêutica/instrumentação , Soluções Esclerosantes/administração & dosagem , Escleroterapia/instrumentação , Adesivos Teciduais/administração & dosagem , Dispositivos de Acesso Vascular , Adulto , Animais , Quimioembolização Terapêutica/instrumentação , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Adulto Jovem
13.
Angiología ; 68(3): 206-217, mayo-jun. 2016. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-151496

RESUMO

«La escleroterapia puede mucho más de lo que en general imaginamos. Teóricamente lo puede todo (Mollard 1994)». En esta reflexión, este cirujano vascular, intuye la potencialidad de los esclerosantes en la nueva forma farmacéutica acabada de nacer. La escleroterapia, procedimiento técnicamente ciego, no evolucionaba, permanecía durante décadas como complemento a la cirugía. No podía progresar porque estaba presa de limitaciones inherentes a la forma líquida de los productos utilizados que impiden hacer suyos los requerimientos básicos de la escleroterapia: a) Conocimiento de la concentración intravascular del esclerosante. b) Homogénea, extensa y manejable distribución sobre las paredes venosas. c) Control del tiempo de contacto esclerosante-endotelio. La clave de la escleroterapia se encierra en el control de la acción de los fármacos esclerosantes y este control se consigue con la forma farmacéutica de espuma inyectable; con ella la escleroterapia rápidamente evoluciona hasta alcanzar una nueva era (AU)


'Sclerotherapy can be much more than we generally imagine. Theoretically, it can be everything. (Mollard 1994)'. In this reflection, a vascular surgeon sensed the potentiality of sclerosing agents in the recently created new pharmaceutical form. Sclerotherapy, technically a blind procedure, did not evolve; it remained as a complement to surgery for years. It was unable to progress because it was a prisoner of the imitations adherent to the liquid form of the products used, which that impeded compliance with the basic requirements of sclerotherapy: a) Knowledge of the intravascular concentration of the sclerosing agent. b) Homogeneous, extensive, and manageable distribution of the venous walls. c) Temperature control of the sclerosing agent-endothelium contact. The key to sclerotherapy involves controlling the action of the sclerosing drugs, and this control is achieved in the pharmaceutical form of an injectable foam, and with this, sclerotherapy rapidly advanced until reaching this new era. Nowadays, different therapies are used in the treatment of varicose veins, including radiofrequency and laser ablation, stripping, surgery, echanical-chemical systems, steam, and glue, with very different outcomes. Sclerotherapy is a minimally invasive technique used for more than a hundred years, and useful for treating tiny little veins, until recently, in 1993, a pharmaceutical grade foam was developed that succeeded in treating large varicose veins, and is imitated by many others. The physical-chemical features of these foams vary considerably among themselves, depending on the production technique, concentration of sclerosing agent, types of gases used, gas/liquid proportion, type of gas/ size of bubble ratio, as well as varying in their safety and therapeutic use. The optimal liquid/gas proportion is obtained when there is sufficient liquid for the bubbles to be spherical and with the smallest diameter possible, but without introducing excess sclerosing liquid, which is described as kugelschaum (wet foam) or alternatively, it forms polyederschaum (dry foam). A series of experimental and theoretical studies have been conducted with the purpose of investigating the mechanical and rheological properties of the foams. However, to study its dynamic behaviour is a challenging theoretical problem, due to the complex interaction between the physical phenomena that occur in different longitudinal scales (that is to say, from the molecular to the macroscopic). And, in this interesting time of the evolution of the injection of drugs deposited over bubbles, is where we currently are (AU)


Assuntos
Humanos , Masculino , Feminino , Escleroterapia/história , Escleroterapia/instrumentação , Escleroterapia , Insuficiência Venosa/prevenção & controle , Insuficiência Venosa/cirurgia , Insuficiência Venosa/terapia , Varizes/complicações , Varizes/patologia , Varizes/cirurgia , Varicocele/prevenção & controle , Varicocele/terapia , Ultrassonografia Doppler/instrumentação , Ultrassonografia Doppler/métodos , Ultrassonografia Doppler , Espumantes
14.
Diagn Interv Radiol ; 22(3): 220-3, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27087190

RESUMO

PURPOSE: We aimed to evaluate the effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts. METHODS: From January 2002 to January 2014, 35 simple breast cysts (mean volume, 8.2 mL; range, 4-33 mL) in 28 females (mean age, 39 years) were evaluated. In a single session, all cysts were aspirated using 20G needles, refilled with 99% ethanol (90% of the volume of the aspirated fluid), and reaspirated completely after 10 minutes of exposure under ultrasound guidance. Follow-up ultrasonography examinations were performed at one week, one month, three months, and six months for all patients and 12 months, 18 months, and 24 months for available patients. Follow- up duration varied between 6 and 24 months (mean, 15 months). RESULTS: The technical success rate of ultrasound-guided percutaneous etha-nol sclerotherapy was 97%. The needle tip was dislocated and ethanol was given into the breast parenchyma in one patient (3%). One cyst (3%) was reaspirated at the first week follow-up due to intracystic hemorrhage. Of the 34 cysts treated, 25 (74%) completely responded to therapy and were no longer detectable on follow-up examinations. Eight cysts (24%) significantly decreased in size and then completely disappeared at six months. At the end of the follow-up period, the clinical success rate reached 100%, and none of the cysts were visible. Except mild to moderate sensation of burning or pain which disappeared or subsided significantly in a couple of minutes, no other complications were observed in patients. CONCLUSION: Ultrasound-guided ethanol sclerotherapy is a fast, safe, and highly effective method in the treatment of simple breast cysts.


Assuntos
Cisto Mamário/diagnóstico por imagem , Cisto Mamário/terapia , Etanol/administração & dosagem , Escleroterapia/métodos , Adulto , Drenagem/instrumentação , Drenagem/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Escleroterapia/instrumentação , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
16.
Cardiovasc Intervent Radiol ; 39(6): 902-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26714694

RESUMO

PURPOSE: The purpose of our study is to evaluate results of percutaneous aspiration with alcohol sclerotherapy in symptomatic patients with simple hepatic cysts by employing single-session techniques either by a needle or a catheter. MATERIALS AND METHODS: We retrospectively included 39 simple hepatic cysts in 35 patients treated via percutaneous aspiration and single-session alcohol sclerotherapy between years 1993 and 2012. Indications were pain (n = 28) or ruling out cystic echinococcus (CE) disease (n = 7). 29 cysts in 26 patients were treated by needle technique (Group A) and ten cysts in nine patients were treated by single-session catheter technique (Group B). Patients were followed for 4-173 months (median: 38 months). RESULTS: All patients were successfully treated. Before procedure, cyst volumes were 21-676 cc (median: 94 cc). Post-procedure cyst volumes at last follow-up were 0-40 cc (median: 1 cc). The mean decrease in cyst volume was 95.92 ± 2.86 % in all patients (95.96 ± 3.26 % in Group A and 95.80 ± 6.20 % in Group B). There was no statistically significant difference between the volume reduction rates of Group A and Group B. Only one patient, in Group B, developed a major complication, an abscess. Hospitalization period was 1 day for all patients. CONCLUSIONS: For patients with symptomatic simple hepatic cysts smaller than 500 cc in volume by using puncture, aspiration, injection, and reaspiration (PAIR) technique with only needle, single-session alcohol sclerotherapy of 10 min is a safe and effective procedure with high success rate.


Assuntos
Cistos/terapia , Hepatopatias/terapia , Escleroterapia/métodos , Adolescente , Adulto , Idoso , Cateteres , Criança , Cistos/diagnóstico , Diagnóstico Diferencial , Equinococose Hepática/diagnóstico , Equinococose Hepática/terapia , Feminino , Humanos , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Agulhas , Estudos Retrospectivos , Escleroterapia/instrumentação , Resultado do Tratamento , Adulto Jovem
17.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 33(6): 1191-5, 2016 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-29715418

RESUMO

Based on the principle of manual preparation of sclerosing foam with Tessari method,using the analysis of user requirements and combining it with theory of mechanics,we designed an automatic equipment.The device could be used to replace the manual operation,and could overcome the shortcomings of manual sclerosing foam preparation,such as the difficulty in controlling of pushing speed and stroke and poor reproducibility.This automatic device has the functions of adjustable pushing speed,pushing frequency,pushing stroke and is suitable for a variety of different types of syringes.It can not only provide quantitative parameters for the study of foam properties,but also be used for the standardization of clinical sclerosing foam.The experimental study on"the effect of pushing speed on the stability of foam"was carried out with using the device,and the experimental results were quite satisfactory.


Assuntos
Soluções Esclerosantes , Escleroterapia/instrumentação , Seringas , Humanos , Reprodutibilidade dos Testes
18.
Klin Khir ; (6): 44-5, 2015 Jun.
Artigo em Ucraniano | MEDLINE | ID: mdl-26521467

RESUMO

The experience of surgical treatment of 50 patients for varicose disease of lower extremities, complicated by trophic ulcers, in the presence of diabetes mellitus type II were analysed. During surgery in patients of the 1st group performed a combined phlebectomy, group 2--scleroobliteration and echoscleroobliteration. Using fleboscleroobliteration method helped reduce the frequency of early postoperative complications in (6.5 +/- 1.3) times.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Pé Diabético/cirurgia , Extremidade Inferior/cirurgia , Escleroterapia/métodos , Úlcera Varicosa/cirurgia , Adulto , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/patologia , Pé Diabético/complicações , Pé Diabético/diagnóstico por imagem , Pé Diabético/patologia , Feminino , Hematoma/etiologia , Hematoma/patologia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Parestesia/etiologia , Parestesia/patologia , Complicações Pós-Operatórias , Período Pós-Operatório , Escleroterapia/instrumentação , Resultado do Tratamento , Ultrassonografia , Úlcera Varicosa/complicações , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/patologia
19.
Phlebology ; 30(2 Suppl): 24-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26556699

RESUMO

In July 2013, the National Institute of Health and Clinical Excellence (NICE) recommended "endothermal" ablation (meaning endovenous thermal ablation) is the first line treatment for truncal venous reflux in varicose veins. The initial endovenous thermoablation devices were radiofrequency ablation and endovenous laser ablation. More recently, Glue (cyanoacrylate), endovenous steam and Clarivein (mechanochemical ablation or MOCA) have entered the market as new endovenous techniques for the treatment of varicose veins. Glue and Clarivein do not require tumescent anaesthesia and do not use heat and therefore termed non-tumescent non-thermal (NTNT). Steam both requires tumescence and is also a thermal technique (TT). This article reviews the current position of these 3 new technologies in the treatment of varicose veins.


Assuntos
Cianoacrilatos/química , Procedimentos Endovasculares/métodos , Varizes/terapia , Adesivos/química , Anestesia , Ablação por Cateter/métodos , Humanos , Terapia a Laser , Veia Safena/cirurgia , Soluções Esclerosantes/química , Escleroterapia/instrumentação , Vapor , Estresse Mecânico
20.
Radiología (Madr., Ed. impr.) ; 57(4): 321-325, jul.-ago. 2015. ilus
Artigo em Espanhol | IBECS | ID: ibc-136623

RESUMO

Objetivo. Estudiar la utilidad clínica de la esclerosis con alcohol guiada con ecografía como tratamiento innovador y alternativo a la intervención quirúrgica de las fístulas de mama. Material y métodos. Estudio retrospectivo basado en los datos recogidos en una Unidad de mama hospitalaria durante tres años (enero de 2011 - diciembre de 2013). El procedimiento consistió en introducir en la luz de la fístula mamaria una solución esclerosante guiada con ecografía. Todos los casos fueron revisados por un comité multidisciplinar, se planteó a las pacientes la esclerosis con alcohol guiada con ecografía como primera opción terapéutica, dejando la intervención quirúrgica para los casos con resultados desfavorables. Resultados. Se reunieron 10 fístulas en 9 mujeres. La mediana de edad fue de 33 años (rango intercuartílico 18,5 años). Cinco pacientes atribuyeron los datos clínicos a mastitis de repetición (50%), cuatro a una intervención quirúrgica previa (40%) y una a la lactancia (10%). Siete pacientes eran fumadoras (78%). El procedimiento se toleró bien, 9 pacientes (90%) puntuaron un valor de uno o 2 en la escala analógica visual del dolor (dolor leve). No hubo complicaciones inmediatas. La respuesta al tratamiento se consideró excelente (ausencia de secreción y cierre completo) en 8 fístulas (80%). Conclusión. La esclerosis con alcohol guiada con ecografía es una alternativa terapéutica a la quirúrgica que ha acabado con la curación del 80% de las fístulas tratadas (AU)


Objective. To study the clinical usefulness of ultrasound-guided alcohol sclerosis as a treatment alternative to surgical intervention for breast fistulas. Material and methods. This was a retrospective study of data collected in a hospital breast unit over a three-year period (January 2011 through December 2013). The procedure consists of introducing a sclerosing solution into the lumen of the breast fistula under ultrasound guidance. All cases were reviewed by a multidisciplinary committee; patients were offered ultrasound-guided alcohol sclerosis as a first treatment option with surgical intervention as a rescue therapy for those with unsatisfactory outcomes. Results. Ten fistulas were treated in 9 women (median age, 33 y; interquartile range 18.5 y). Five patients (50%) attributed the clinical findings to recurrent mastitis, four (40%) to a previous surgical intervention, and one (10%) to lactation. Seven patients (78%) were smokers. The procedure was well tolerated: nine patients (90%) rated the pain as one or 2 (mild pain) on a visual analogue scale. There were no immediate complications. The response to treatment was considered excellent (absence of secretion and complete closure) in eight fistulas (80%). Conclusion. Ultrasound-guided alcohol sclerosis achieved excellent outcomes in 80% of cases and is a viable alternative to surgical treatment (AU)


Assuntos
Adulto , Humanos , Esclerose/complicações , Esclerose , Fístula/complicações , Fístula , Mastite/complicações , Mastite , Escleroterapia/instrumentação , Escleroterapia/métodos , Escleroterapia , Estudos Retrospectivos , Mamilos/patologia , Mamilos , Etanol/uso terapêutico , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Ultrassonografia Mamária/tendências , Ultrassonografia Mamária
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