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1.
Tech Vasc Interv Radiol ; 22(4): 100631, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864533

RESUMO

The approach to treating common (cystic) lymphatic malformations (LMs) has evolved significantly over the last decade due to clinical research and recent developments in molecular biology. Surgery, sclerosing agents, and medical drugs with specific targets for biological therapy have been reported for the management of LMs. We will discuss the importance to standardize the location and imaging characterization of LMs to improve the knowledge about the outcome of the different therapeutic options. Our goal is to help the reader understand the different options for the management of LMs with the balance between risk and benefit for the patients.


Assuntos
Cistos/terapia , Anormalidades Linfáticas/cirurgia , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Cistos/diagnóstico por imagem , Cistos/fisiopatologia , Humanos , Anormalidades Linfáticas/diagnóstico por imagem , Anormalidades Linfáticas/fisiopatologia , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento
2.
Tech Vasc Interv Radiol ; 22(4): 100630, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864535

RESUMO

Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.


Assuntos
Procedimentos Endovasculares , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Malformações Vasculares/terapia , Veias/anormalidades , Tomada de Decisão Clínica , Terapia Combinada , Procedimentos Endovasculares/efeitos adversos , Humanos , Seleção de Pacientes , Fatores de Risco , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Veias/diagnóstico por imagem , Veias/fisiopatologia
3.
Angiol Sosud Khir ; 25(4): 102-107, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855206

RESUMO

AIM: The purpose of the study was to assess efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® in decreasing the incidence and treatment of the most common local adverse reactions in patients after endured sclerotherapy of reticular veins and telangiectasias. PATIENTS AND METHODS: Our open prospective observational study included a total of sixty 18-to-35-year-old female patients who after undergoing standardized sclerotherapy of reticular veins and telangiectasias on symmetrical portions of lower limbs were given a tube of heparin sodium gel 1000 IU/g or Detragel® to be applied onto the skin of one (left) lower limb in the projection of the sclerotherapy-exposed vessels 2-3 times daily for 10 days followed by putting on a compression class 2 (RAL standard) stocking. The women were allowed to use only the paired stocking on the contralateral extremity. Efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® were evaluated based on the incidence of typical adverse reactions (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as on the patient's subjective perceptions. RESULTS: The use of heparin sodium gel 1000 IU/g and Detragel® in addition to compression after sclerotherapy of reticular veins and telangiectasias significantly and comparably decreased the incidence and accelerated the resolution of ecchymoses and phlebitides associated with phlebosclerosing treatment. The Detragel® group patients were found to develop hyperpigmentation or neovasculogenesis significantly less often as compared with the heparin sodium gel 1000 IU/g group women. What is more, using Detragel® was not accompanied by hyperkeratosis, pruritus or formation of a sticky film, the events, however, observed while applying heparin sodium gel 1000 IU/g. CONCLUSION: The use of Detragel® or heparin sodium gel 1000 IU/g for 10 days additionally to compression significantly decreased the incidence of typical undesirable reactions associated with sclerotherapy of reticular veins and telangiectasias. The Detragel® group women turned out to have lower incidence of hyperpigmentation and neovasculogenesis. Besides, Detragel® demonstrated better organoleptic properties.


Assuntos
Anticoagulantes/administração & dosagem , Heparina/administração & dosagem , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Telangiectasia/terapia , Varizes/terapia , Administração Tópica , Feminino , Géis/administração & dosagem , Humanos , Hiperpigmentação/etiologia , Hiperpigmentação/prevenção & controle , Incidência , Neovascularização Patológica/etiologia , Neovascularização Patológica/prevenção & controle , Estudos Prospectivos , Meias de Compressão
4.
J Dermatol ; 46(9): 770-776, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31270853

RESUMO

The efficacy of lauromacrogol injection therapy and intralesional triamcinolone for infantile hemangiomas (IH) has been well documented recently, but with an increase in serious or rare adverse reactions. The aim of this study is to investigate the safety concerns regarding intralesional injection of lauromacrogol combined with triamcinolone for IH and to study its effect on infant growth and development. A total of 1039 IH patients who were subjected to intralesional injection of lauromacrogol combined with triamcinolone in the Plastic Surgery Department of Shandong Provincial Hospital between 1 January 2015 and 31 May 2018 were enrolled in this study. When the dose of lauromacrogol and triamcinolone was less than 3.5 and 2.0 mg/kg respectively, no serious side-effects were observed. The adverse event rate reported was 7.7%. Among the 405 patients not subjected to propranolol before the last injection, the study included three modes of treatment response: regression (82.7%), stabilization (13.8%) and failure (3.5%). By comparing height and weight to the reference standards and also by comparisons between the same-sex groups, our results confirmed that there was no significant effect on children's height and weight, regardless of whether the injection therapy was combined with oral propranolol at the appropriate dose and with more than 4-week intervals. Intralesional injection of lauromacrogol combined with triamcinolone in the treatment of IH was highly safe and effective.


Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Hemangioma/tratamento farmacológico , Polidocanol/efeitos adversos , Soluções Esclerosantes/efeitos adversos , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Estatura/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Relação Dose-Resposta a Droga , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Lactente , Injeções Intralesionais , Masculino , Polidocanol/administração & dosagem , Propranolol/administração & dosagem , Propranolol/efeitos adversos , Estudos Retrospectivos , Soluções Esclerosantes/administração & dosagem , Resultado do Tratamento , Triancinolona/administração & dosagem , Triancinolona/efeitos adversos
5.
Int J Dermatol ; 58(8): 982-986, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31099425

RESUMO

On July 25, 2017, we conducted an extensive database tracking to identify all studies published from January 1990 to July 2017. Screening updates were performed until December 2017. RESULTS: There were no deaths, and the resolution of symptoms of primary plantar hyperhidrosis (PPH) occurred in 92% of patients after mechanical sympathectomy. A total of 177 patients (44%) were reported to have mild to severe compensatory sweating after a mean 6 months follow-up. The preservation of L2 did not interfere with the primary outcome, and it is possible to perform lumbar sympathectomy in men with L2 preservation, achieving satisfactory cure results of PPH, minimizing the risk of sexual dysfunction. There were no deaths, and the resolution of symptoms of PPH occurred in 10% of patients after chemical sympathicolysis after a mean 6 months follow-up. A total of 13 patients (12.5%) were reported to have mild to severe compensatory sweating using the same technique. CONCLUSION: The mechanical lumbar sympathectomy is effective and safe and improves quality of life, evaluated by the high symptom resolution of PPH and low rate of complications. The chemical sympathicolysis in the immediate postoperative period presented satisfactory results; however, it was shown to be significantly less effective than the mechanical approach in a follow-up of at least 6 months.


Assuntos
Hiperidrose/terapia , Plexo Lombossacral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Soluções Esclerosantes/administração & dosagem , Simpatectomia/métodos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , , Humanos , Hiperidrose/diagnóstico , Hiperidrose/psicologia , Plexo Lombossacral/efeitos dos fármacos , Masculino , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Soluções Esclerosantes/efeitos adversos , Índice de Gravidade de Doença , Fatores Sexuais , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Simpatectomia/efeitos adversos , Resultado do Tratamento
6.
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
7.
Artigo em Chinês | MEDLINE | ID: mdl-30704167

RESUMO

Objective: To investigate the efficacy and safety of percutaneous lauromacrogol injection (PLI) in treatment of cystic or predominantly cystic thyroid nodules. Methods: A total of 114 cystic thyroid nodules and 61 predominantly cystic thyroid nodules with pain or uncomfort or aesthetic complaints were offered PLI. Therapeutic success rates and side effects were evaluated. From October 2012 to December 2015,114 patients with cystic thyroid nodules and 61 with predominantly cystic thyroid nodules with pain or uncomfortable or aesthetic complaints at the outpatient clinic of the First Affiliated Hospital of Wenzhou Medical University were offered percutaneous lauromacrogol sclerotherapy. Cytological results were benign. This study was a prospective trial. Ultrasonography sound examination was performed in all patients before treatment. The baseline data of all the patients and the data of the patients examined at the follow-up of 1, 3, 6 and 12 months were analyzed. Therapeutic success rate (nodule volume reduction >50%) and safety were observed. The data of nodule volume reduction ratio and the function of thyroid were normal distribution and analyzed by Mann-Whitney test and t test. The data of nodule volume, symptoms score and cosmetic score were skewed distribution, which were indicated with median and analyzed by nonparamentic test. Results: The mean volume of the cystic thyroid nodules was reduced from 12.5 cm(3) before PLI to 0.2 cm(3) at 12 months after PLI (χ(2)=266.175, P<0.001), with a therapeutic success rate of 100%, and the mean volume of the predominantly cystic thyroid nodules was reduced from 10.5 cm(3) before PLI to 2.0 cm(3) at 12 months after PLI (χ(2)=203.122, P<0.001) with a therapeutic success rate of 93.4%(57/61). Pressure symptom score and cosmetic grade were significantly improved at 12 months after PLI in patients with cystic or predominantly cystic thyroid nodules. Pressure symptom score and cosmetic grade in patients with cystic thyroid nodules were Z=-6.126 and Z=-13.735, respectively; pressure symptom score and cosmetic grade in patients with predominantly cystic thyroid nodules were Z=-3.126 and Z=-7.212, respectively (all P<0.001) . There no significant difference in the thyroid functions before and after PLI in two groups of patients (all P>0.05) . The side effects of PLI were mild. Conclusion: PLI is a safe and effective alternative to treat benign cystic or predominantly cystic thyroid nodules.


Assuntos
Cistos/terapia , Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Doenças da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/terapia , Ultrassonografia de Intervenção , Humanos , Polidocanol/efeitos adversos , Estudos Prospectivos , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento
8.
BMC Gastroenterol ; 19(1): 23, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717684

RESUMO

BACKGROUND: The management of acute esophageal variceal bleeding remains a clinical challenge. Band ligation is the main therapeutic option, but it may be technically difficult to perform in active bleeders. This may necessitate an alternative therapy for this group of patients. This study was conducted to assess the safety and efficacy of sclerotherapy versus cyanoacrylate injection for management of actively bleeding esophageal varices in cirrhotic patients. METHODS: This prospective study included 113 cirrhotic patients with actively bleeding esophageal varices. They were randomly treated by endoscopic sclerotherapy or cyanoacrylate injection as banding was not suitable for those patients due to profuse bleeding making unclear endoscopic visual field. Primary outcome was incidence of active bleeding control and secondary outcomes were incidence of six weeks rebleeding, complications, and mortality among the studied patients. RESULTS: Initial bleeding control was significantly higher in cyanoacrylate versus sclerotherapy groups (98.25, 83.93% respectively, P = 0.007). No significant differences between sclerotherapy and cyanoacrylate groups regarding rebleeding (26.79, 19.30% respectively, P = 0.344), complications, hospital stay or mortality rate were observed. CONCLUSIONS: Based on this single-center prospective study, both of these therapies appear to have relatively favorable outcomes, although cyanoacrylate injection may be superior to sclerotherapy for initial control of active bleeding. TRIAL REGISTRATION: [ClinicalTrials.gov Identifier: NCT03388125 ]-Date of registration: January 2, 2018 "Retrospectively registered".


Assuntos
Embucrilato/administração & dosagem , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Embucrilato/efeitos adversos , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/complicações , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos
9.
Ann R Coll Surg Engl ; 101(4): 285-289, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30602297

RESUMO

INTRODUCTION: This prospective study of foam sclerotherapy for varicose veins aimed to determine the outcomes of treatment including ulcer healing and complication rates in our unit. Data were collected prospectively over a 10-year period and maintained on a database by our vascular sciences unit, which performed the planning and post-treatment venous duplex scans. Patients undergoing treatment due to venous ulceration were identified from this database. An initial cohort of patients underwent a follow-up scan and assessment at one year. MATERIALS AND METHODS: Patients were treated with foam sclerotherapy, in multiple sessions if required, to occlude all incompetent superficial veins greater than 3 mm in size. We used 3% sodium tetradecyl sulphate as our sclerosing agent, according to our departmental protocol, followed by a period of compression therapy. Patients underwent pre- and post-treatment scans to assess venous competence, the effects of treatment and any complications that arose. RESULTS: We identified 336 patients treated for clinical, aetiological, anatomical and pathophysiological stage 5/6 venous ulceration. At six weeks post-treatment, 21% had fully healed ulcers and a further 46.1% were clinically improving with no further venous incompetence. The remainder continued treatment. An initial cohort of 162 patients was assessed at one year and 77.1% ulcers remained healed. The remainder demonstrated some venous incompetence and ultimately 12.5% required further treatment. Our complication rates were similar to those quoted in published meta-analyses including a deep vein thrombosis rate of 1.16%. CONCLUSIONS: Foam sclerotherapy remains a useful treatment option for venous ulceration with a low morbidity rate.


Assuntos
Escleroterapia , Úlcera Varicosa/terapia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Soluções Esclerosantes/efeitos adversos , Soluções Esclerosantes/uso terapêutico , Escleroterapia/efeitos adversos , Escleroterapia/métodos , Cicatrização/efeitos dos fármacos
11.
Asian Cardiovasc Thorac Ann ; 27(2): 93-97, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30525867

RESUMO

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.


Assuntos
Fístula Brônquica/terapia , Broncoscopia , Etanolamina/administração & dosagem , Pneumonectomia/efeitos adversos , Polidocanol/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Idoso , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Broncoscopia/efeitos adversos , Etanolamina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol/efeitos adversos , Estudos Prospectivos , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
12.
Orbit ; 38(4): 300-304, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30424707

RESUMO

Purpose: The aim of this study was to perform a histopathological assessment of the efficacy of sclerosing agents in dacryocystosclerotherapy (DCST) and to evaluate its role as an alternative to dacryocystectomy (DCT) in a specific group of patients. Methods: Thirteen lacrimal drainage systems of 10 patients with primary acquired nasolacrimal duct obstruction (PANDO) were studied. All patients were awaiting a DCT, indications being repeated attacks of dacryocystitis with severe systemic or ocular co-morbidities and/or refusal for a dacryocystorhinostomy. Fluorescent labelled sodium tetradecyl sulphate (SDS) or bleomycin were used as sclerosing agents for a DCST taking specific precautions. All patients underwent a DCT after 4 weeks and histopathological evaluation was performed to assess the changes and extent of DCST. Results: There were nine females and one male, and all patients were above the age of 60 years. Of the 13 lacrimal systems studied, the mean duration of PANDO was 1.3 years. All the patients had associated systemic and/or ocular co-morbidities. SDS and bleomycin were used in 6 and 7 lacrimal systems, respectively. The mean doses used for SDS and bleomycin were 0.26 and 0.31 cc, respectively. The post-injection phase was uneventful except for one patient who had a moderate inflammation, which resolved with low dose oral steroids. Histopathological features were more marked in the SDS group and included loss of epithelium, luminal closure, gross fibrosis across the lacrimal sac wall, congestion and hyalinization of blood vessels, and multiple areas of haemorrhages in the sac wall. Conclusions: DCST is a safe and effective alternative to DCT in very carefully selected patients. Histopathology demonstrates SDS to be more effective as compared to bleomycin.


Assuntos
Obstrução dos Ductos Lacrimais/terapia , Ducto Nasolacrimal/patologia , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Bleomicina/efeitos adversos , Bleomicina/uso terapêutico , Dacriocistorinostomia , Feminino , Fluoresceína/efeitos adversos , Fluoresceína/uso terapêutico , Humanos , Obstrução dos Ductos Lacrimais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Soluções Esclerosantes/efeitos adversos , Tetradecilsulfato de Sódio/efeitos adversos , Tetradecilsulfato de Sódio/uso terapêutico , Resultado do Tratamento
13.
Angiology ; 70(5): 388-396, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29874921

RESUMO

Varicose veins are a very common condition and have been the subject of a recent proliferation of treatment modalities. The advent of the endovenous treatment era has led to a confusing array of different techniques that can be daunting when making the transition from traditional surgery. All modalities offer excellent results in the right situation, and each has its own treatment profile. Thermal ablation techniques have matured and have a reassuring and reliable outcome, but the arrival of nonthermal techniques has delivered further options for both patient and surgeon. This article provides an overview of the different treatment devices and modalities available to the modern superficial vein surgeon and details the currently available evidence and summation analysis to help surgeons to make an appropriate treatment choice for their patients.


Assuntos
Técnicas de Ablação , Cianoacrilatos/administração & dosagem , Embolização Terapêutica , Procedimentos Endovasculares , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Varizes/terapia , Técnicas de Ablação/efeitos adversos , Tomada de Decisão Clínica , Cianoacrilatos/efeitos adversos , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Seleção de Pacientes , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Varizes/diagnóstico , Varizes/fisiopatologia
15.
Retin Cases Brief Rep ; 13(2): 185-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28267111

RESUMO

PURPOSE: Cosmetic vein sclerotherapy is increasingly used to treat varicose veins because of its effectiveness and adherence with British Pharmacopoeia specifications. We present the first documented case of ophthalmic artery occlusion resulting in panocular ischemia secondary to intravascular injection of sodium tetradecyl sulfate sclerosant in a young healthy women seeking treatment for prominent facial veins in her forehead. METHODS: The patient presented with unilateral sudden loss of vision. Funduscopy demonstrated a pale retina, cherry-red spot, and sclerosant visualized directly at the macula. She underwent emergency treatment for central retinal artery occlusion followed by fundal photographs, fluorescein angiography, and optical coherence tomography. RESULTS: Despite intervention, the vision remained no perception to light. Magnetic resonance imaging, echocardiography, and Doppler ultrasound were unremarkable. The patient later developed neovascular sequelae requiring laser pan-retinal photocoagulation. CONCLUSION: Widely regarded as safe, and approved by the U.S. Food and Drug Administration, the only published ocular side effects of foam sclerotherapy are transient visual disturbances or temporary scotomas. This case demonstrates irreversible loss of vision as a previously unreported complication. While undoubtedly rare, we believe physicians and surgeons using sclerosant in the orbital adnexa, face, nose, and sinuses should be aware of this sight-threatening complication of injection and counsel potential patients accordingly.


Assuntos
Arteriopatias Oclusivas/induzido quimicamente , Cegueira/induzido quimicamente , Técnicas Cosméticas/efeitos adversos , Artéria Oftálmica , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Tetradecilsulfato de Sódio/efeitos adversos , Adulto , Feminino , Testa , Humanos , Oclusão da Artéria Retiniana/induzido quimicamente
16.
Ther Adv Respir Dis ; 12: 1753466618816625, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30526440

RESUMO

BACKGROUND: Autologous blood is a novel, high-efficacy sclerosant for treatment of malignant pleural effusion (MPE), similar to tetracycline. There has been no comparative data between autologous blood and a worldwide sclerosant like talc. We aimed to compare the effectiveness of autologous blood versus talc pleurodesis. METHODS: A prospective study was conducted at Songklanagarind Hospital, Songkhla, Thailand. A total of 123 symptomatic MPE cases were randomized to receive autologous blood pleurodesis (ABP) versus pleurodesis with talc slurry. In the ABP group, 100 ml of autologous venous blood was instilled through a chest drain, followed by 50 ml of sterile normal saline (NSS). In the talc group, 20 ml of 1% lidocaine diluted in 30 ml NSS was instilled, followed by 4 g of sterile talc (Steritalc®, a non-small particle size talc) suspended in 100 ml of NSS. A 30-day pleurodesis efficacy (according to Paladine's criteria), along with the adverse events, was evaluated. RESULTS: Fifty-six cases in the ABP, and 54 cases in the talc group completed the study. There was no difference between the two groups in the demographic data. The overall pleurodesis success rate at 30 days was 82.0% in the ABP group, comparable to the talc pleurodesis group (87.0%, p = 0.12). The percentage of fever (9.0% versus 28.0%, p = 0.04), amount of acetaminophen required by each participant (2.2 ± 0.7 versus 4.6 ± 0.9 tablets, p = 0.03), pain score and percentage of cases who needed opioids (9.0% versus 26.0%, p = 0.02) and hospital stay (10.2 ± 2.7 versus 12.8 ± 3.4, p = 0.04) were significantly lower in the ABP group; no infectious or serious events occurred. CONCLUSIONS: ABP had an equivalent efficacy compared to talc pleurodesis for MPE treatment. ABP offered less fever and pain and could shorten hospital stays, and neither produced means ABP did not produce clotted drainage, pulmonary or systemic adverse events.


Assuntos
Sangue , Derrame Pleural Maligno/terapia , Pleurodese/métodos , Soluções Esclerosantes/administração & dosagem , Talco/administração & dosagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico , Pleurodese/efeitos adversos , Estudos Prospectivos , Soluções Esclerosantes/efeitos adversos , Talco/efeitos adversos , Tailândia , Fatores de Tempo , Resultado do Tratamento
17.
J Vasc Surg Venous Lymphat Disord ; 6(6): 707-716, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30108030

RESUMO

OBJECTIVE: Ultrasound-guided foam sclerotherapy (UGFS) is a low-cost and minimally invasive treatment option for varicose veins. There is a relative paucity of outcome reports. METHODS: UGFS procedures at a tertiary public hospital between 2010 and 2017 were studied. Either the great saphenous vein (GSV) or small saphenous vein (SSV) was treated. Pretreatment, in-treatment, 6-week, and 1-year post-treatment ultrasound reports were analyzed. The primary outcome was to determine whether vein diameter predicts obliteration failure. RESULTS: There were 457 treatments completed in 290 patients. The GSV was targeted in 372 (81%). Mean vein diameters of the GSV were not different from those of the SSV (GSV, 5.7 mm; SSV, 6.2 mm; P = .18); 109 (24%) had a Clinical, Etiology, Anatomy, and Pathophysiology score of at least 4. Of the 457 UGFS procedures, 360 (78.8%) were for primary veins. Baseline information, including vein diameter, was not different between primary and recurrent veins. At 6 weeks, complete obliteration, partial recanalization, and complete recanalization rates were 54.9%, 29.1%, and 16%, respectively. Of those with complete obliteration at 6 weeks, the recanalization rate at 1 year was 25%. Increasing vein diameter was associated with recanalization at 1 year (obliteration, 4.9 mm; recanalization, 5.7 mm; P = .03), especially for primary veins (4.8 vs 5.8 mm; P = .009). Multivariate analysis showed similar outcome. Vein diameter of >6 mm had good specificity (88%) but poor sensitivity (43%) for predicting obliteration failure. There were 15 (3%) new-onset deep venous thromboses reported on follow-up, all of which were from treatment of primary veins (P = .049). CONCLUSIONS: Only 44% of UGFS procedures were observed to have complete obliteration at 1 year after a single intervention. Significant recanalization developed at 1 year. Increased vein diameter was associated with recanalization. The impact on clinical recurrence is unknown.


Assuntos
Polidocanol/administração & dosagem , Veia Safena , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Ultrassonografia de Intervenção , Varizes/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Veia Safena/diagnóstico por imagem , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Varizes/diagnóstico por imagem
18.
J Vasc Surg Venous Lymphat Disord ; 6(4): 477-484, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29909854

RESUMO

OBJECTIVE: This study measured patient outcomes among symptomatic patients with superficial chronic venous insufficiency who were treated with retrograde ultrasound-guided polidocanol microfoam 1% in a community setting. METHODS: Between March 2015 and June 2017, 250 symptomatic patients with C2-C6 chronic venous insufficiency received polidocanol microfoam 1% and were followed for 16 ± 7 months. Sixteen of the 250 patients (6.4%) had skin ulcers, and 56 (22.4%) were treated previously with thermal or surgical interventions. All patients underwent a duplex ultrasound venous incompetence study to map perforators and veins to be treated. Incompetent veins were accessed with a micropuncture needle distal to the midthigh perforator, approximately 10 cm above the knee fold. The leg was then elevated 45°. Under ultrasound guidance, the incompetent greater saphenous vein was closed with polidocanol microfoam 1%. A second injection was administered through the same catheter directing the microfoam to flow in a retrograde fashion through the incompetent venous valves to the ankle. RESULTS: All patients completed the initial treatment; 55 (22.0%) required planned secondary treatment during the follow-up period for residual venous reflux in the below-knee greater saphenous vein. Complete elimination of venous valvular reflux and symptom improvement was documented in 236 patients (94.4%). Minor adverse events included asymptomatic deep vein thrombi (n = 2), common femoral vein thrombus extension (n = 1), and superficial venous thrombi (n = 4). Of the 16 patients with skin ulcers, 10 were C6 patients and 80% experienced wound closure within 4 weeks of treatment. CONCLUSIONS: Retrograde administration of polidocanol microfoam 1% is a safe and effective treatment with important clinical benefit for superficial venous insufficiency in community practice.


Assuntos
Procedimentos Endovasculares/métodos , Úlcera da Perna/terapia , Polietilenoglicóis/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Ultrassonografia de Intervenção , Insuficiência Venosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Úlcera da Perna/diagnóstico por imagem , Úlcera da Perna/fisiopatologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Polidocanol , Polietilenoglicóis/efeitos adversos , Recuperação de Função Fisiológica , Retratamento , Estudos Retrospectivos , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Cicatrização
19.
Ann Vasc Surg ; 52: 176-182, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29772321

RESUMO

BACKGROUND: Chronic venous insufficiency (CVI) is a widely prevalent condition. Saphenous venous reflux is the most common underlying pathology that leads to CVI. Endovenous thermal ablations (ETA) are the current gold standard. However, some patients present with some unique challenges making ETA less ideal. Nonthermal nontumescent therapies could be considered as alternative therapy in these patients. METHODS: We performed a retrospective review of treatment effects with United States Food and Drug Administration-approved polidocanol endovenous microfoam (PEM; Varithena® 1%) on venous symptomology in 10 (n = 10) C3-C6 patients with CVI and concomitant complex disease/pathology that limited the use of ETA. The pathology included risk of bruising or bleeding, severe lipodermatosclerosis, hidradenitis suppurativa, chronic fibrosis of the vein from prior superficial thrombosis, risk for nerve injury, and failed prior ETA. Before treatment, all patients underwent a venous incompetence study by duplex ultrasound (DUS). Preprocedure pain, symptoms, and Venous Clinical Severity Scores (VCSSs) were recorded. Clinical assessments and DUS were performed 4 days, 6 weeks, 6 months, and 1 year after treatment. RESULTS: DUS demonstrated reflux in the great saphenous vein (GSV), anterior accessory GSV, and/or the small saphenous vein. Pain scores and VCSS were reduced 4 days and 6 weeks after treatment. These lower scores were maintained for up to 1 year after treatment. CONCLUSIONS: PEM use in C3-C6 patients resulted in successful improvement in VCSS, CVI symptoms, and wound healing among patients in whom ETA was not considered to be the optimal therapy.


Assuntos
Procedimentos Endovasculares , Hemodinâmica , Polidocanol/administração & dosagem , Veia Safena/fisiopatologia , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Varizes/terapia , Insuficiência Venosa/terapia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol/efeitos adversos , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Varizes/complicações , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Cicatrização
20.
Tech Vasc Interv Radiol ; 21(2): 45-54, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29784122

RESUMO

Venous malformations are the most common type of congenital vascular malformation. The diagnosis and management of venous malformations may be challenging, as venous malformations may be located anywhere in the body and range from small and superficial to large and extensive lesions. There are many treatment options for venous malformations including systemic targeted drugs, open surgery, sclerotherapy, cryoablation, and laser photocoagulation. This article reviews the natural history, clinical evaluation, imaging diagnosis, and treatment modalities of venous malformations.


Assuntos
Criocirurgia/métodos , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Malformações Vasculares/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Veias/cirurgia , Adolescente , Pré-Escolar , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/epidemiologia , Malformações Vasculares/fisiopatologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Veias/anormalidades , Veias/diagnóstico por imagem , Veias/fisiopatologia
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