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Ishikawa K, Maeda T, Funayama E, Murao N, Miura T, Sasaki Y, Seo D, Mitamura S, Oide S, Yamamoto Y, Sasaki S. Fluoroscopy- and Endoscopy-Guided Transoral Sclerotherapy Using Foamed Polidocanol for Oropharyngolaryngeal Venous Malformations in a Hybrid Operation Room: A Case Series. J Clin Med 2024; 13:2369. [PMID: 38673643 PMCID: PMC11050875 DOI: 10.3390/jcm13082369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Treatment of oropharyngolaryngeal venous malformations (VMs) remains challenging. This study evaluated the effectiveness and safety of fluoroscopy- and endoscopy-guided transoral sclerotherapy for oropharyngolaryngeal VMs in a hybrid operation room (OR). Methods: Patients with oropharyngolaryngeal VMs who underwent transoral sclerotherapy in a hybrid OR were enrolled. Results: Fourteen patients (six females, eight males; median age of 26 years; range, 4-71 years) were analyzed. The symptoms observed were breathing difficulties (n = 3), snoring (n = 2), sleep apnea (n = 1), and swallowing difficulties (n = 1). Lesions were extensive in the face and neck (n = 9) and limited in the oropharyngolarynx (n = 5). A permanent tracheostomy was performed on two patients, while a temporary tracheostomy was performed on five patients. The treated regions were the soft palate (n = 8), pharynx (n = 7), base of the tongue (n = 4), and epiglottis (n = 1). The median number of sclerotherapy sessions was 2.5 (range, 1-9). The median follow-up duration was 81 months (range, 6-141). Treatment outcomes were graded as excellent (n = 2), good (n = 7), or fair (n = 5). The post-treatment complication was bleeding (n = 1), resulting in an urgent tracheostomy. Conclusions: Fluoroscopy- and endoscopy-guided transoral sclerotherapy in a hybrid OR can be effective and safe for oropharyngolaryngeal VMs.
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Affiliation(s)
- Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
| | - Emi Funayama
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
| | - Naoki Murao
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Takahiro Miura
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
| | - Yuki Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Dongkyung Seo
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Shintaro Mitamura
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Shunichi Oide
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.M.); (Y.S.); (D.S.); (S.M.); (S.O.)
| | - Satoru Sasaki
- Center for Vascular Anomalies, Department of Plastic and Reconstructive Surgery, Tonan Hospital, Sapporo 060-0004, Japan
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FAKHRY AM, NAGIB SA. CLaCS for vanishing spider veins: early Egyptian experience. ACTA PHLEBOLOGICA 2023. [DOI: 10.23736/s1593-232x.22.00555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Mysore V, Garg A. Dermatologic and cosmetic procedures in pregnancy. J Cutan Aesthet Surg 2022; 15:108-117. [PMID: 35965909 PMCID: PMC9364454 DOI: 10.4103/jcas.jcas_226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Materials and Methods: Results:
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de Ávila Oliveira R, Riera R, Vasconcelos V, Baptista-Silva JC. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev 2021; 12:CD001732. [PMID: 34883526 PMCID: PMC8660237 DOI: 10.1002/14651858.cd001732.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Varicose veins are enlarged and tortuous veins, affecting up to one-third of the world's population. They can be a cause of chronic venous insufficiency, which is characterised by oedema, pigmentation, eczema, lipodermatosclerosis, atrophie blanche, and healed or active venous ulcers. Injection sclerotherapy (liquid or foam) is widely used for treatment of varicose veins aiming to transform the varicose veins into a fibrous cord. However, there is limited evidence regarding its effectiveness and safety, especially in patients with more severe disease. This is the second update of the review first published in 2002. OBJECTIVES To assess the effectiveness and safety of injection sclerotherapy for the treatment of varicose veins. SEARCH METHODS For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL, and LILACS databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries, on 20 July 2021. SELECTION CRITERIA We included all randomised controlled trials (RCTs) (including cluster-randomised trials and first phase cross-over studies) that used injection sclerotherapy for the treatment of varicose veins. DATA COLLECTION AND ANALYSIS Two review authors independently assessed, selected and extracted data. Disagreements were cross-checked by a third review author. We used Cochrane's Risk of bias tool to assess the risk of bias. The outcomes of interest were cosmetic appearance, complications, residual varicose veins, quality of life (QoL), persistence of symptoms, and recurrent varicose veins. We calculated risk ratios (RRs) or mean difference (MD) with 95% confidence intervals (CIs). We used the worst-case-scenario for dichotomous data imputation for intention-to-treat analyses. For continuous outcomes, we used the 'last-observation-carried-forward' for data imputation if there was balanced loss to follow-up. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 23 new RCTs for this update, bringing the total to 28 studies involving 4278 participants. The studies differed in their design, and in which sclerotherapy method, agent or concentration was used. None of the included RCTs compared sclerotherapy to no intervention or to any pharmacological therapy. The certainty of the evidence was downgraded for risk of bias, low number of studies providing information for each outcome, low number of participants, clinical differences between the study participants, and wide CIs. Sclerotherapy versus placebo Foam sclerotherapy may improve cosmetic appearance as measured by IPR-V (independent photography review - visible varicose veins scores) compared to placebo (polidocanol 1%: mean difference (MD) -0.76, 95% CI -0.91 to -0.60; 2 studies, 223 participants; very low-certainty evidence); however, deep vein thrombosis (DVT) rates may be slightly increased in this intervention group (RR 5.10, 95% CI 1.30 to 20.01; 3 studies, 302 participants; very low-certainty evidence). Residual varicose vein rates may be decreased following polidocanol 1% compared to placebo (RR 0.19, 95% CI 0.13 to 0.29; 2 studies, 225 participants; very low-certainty evidence). Following polidocanol 1% use, there may be a possible improvement in QoL as assessed using the VEINES-QOL/Sym questionnaire (MD 12.41, 95% CI 9.56 to 15.26; 3 studies, 299 participants; very low-certainty evidence), and possible improvement in varicose vein symptoms as assessed using the Venous Clinical Severity Score (VCSS) (MD -3.25, 95% CI -3.90 to -2.60; 2 studies, 223 participants; low-certainty evidence). Recurrent varicose veins were not reported for this comparison. Foam sclerotherapy versus foam sclerotherapy with different concentrations Three individual RCTs reported no evidence of a difference in cosmetic appearance after comparing different concentrations of the intervention; data could not be pooled for two of the three studies (RR 1.11, 95% CI 0.84 to 1.47; 1 study, 80 participants; very low-certainty evidence). Similarly, there was no clear difference in rates of thromboembolic complications when comparing one foam concentration with another (RR 1.47, 95% CI 0.41 to 5.33; 3 studies, 371 participants; very low-certainty evidence). Three RCTs investigating higher concentrations of polidocanol foam indicated the rate of residual varicose veins may be slightly decreased in the polidocanol 3% foam group compared to 1% (RR 0.67, 95% CI 0.43 to 1.04; 3 studies, 371 participants; moderate-certainty evidence). No clear improvement in QoL was detected. Two RCTs reported improved VCSS scores with increasing concentrations of foam. Persistence of symptoms were not reported for this comparison. There was no clear difference in recurrent varicose vein rates (RR 0.91, 95% CI 0.62 to 1.32; 1 study, 148 participants; low-certainty evidence). Foam sclerotherapy versus liquid sclerotherapy One RCT reported on cosmetic appearance with no evidence of a difference between foam or liquid sclerotherapy (patient satisfaction scale MD 0.2, 95% CI -0.27 to 0.67; 1 study, 126 participants; very low-certainty evidence). None of the RCTs investigated thromboembolic complications, QoL or persistence of symptoms. Six studies individually showed there may be a benefit to polidocanol 3% foam over liquid sclerotherapy in reducing residual varicose vein rate; pooling data from two studies showed a RR of 0.51, with 95% CI 0.41 to 0.65; 203 participants; very low-certainty evidence. One study reported no clear difference in recurrent varicose vein rates when comparing sodium tetradecyl sulphate (STS) foam or liquid (RR 1.10, 95% CI 0.86 to 1.42; 1 study, 286 participants; very low-certainty evidence). Sclerotherapy versus sclerotherapy with different substances Four RCTs compared sclerotherapy versus sclerotherapy with any other substance. We were unable to combine the data due to heterogeneity or assess the certainty of the evidence due to insufficient data. AUTHORS' CONCLUSIONS There is a very low to low-certainty evidence that, compared to placebo, sclerotherapy is an effective and safe treatment for varicose veins concerning cosmetic appearance, residual varicose veins, QoL, and persistence of symptoms. Rates of DVT may be slightly increased and there were no data concerning recurrent varicose veins. There was limited or no evidence for one concentration of foam compared to another; foam compared to liquid sclerotherapy; foam compared to any other substance; or one technique compared to another. There is a need for high-quality trials using standardised sclerosant doses, with clearly defined core outcome sets, and measurement time points to increase the certainty of the evidence.
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Affiliation(s)
| | - Rachel Riera
- Cochrane Brazil Rio de Janeiro, Cochrane, Petrópolis, Brazil
| | - Vladimir Vasconcelos
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose Cc Baptista-Silva
- Evidence Based Medicine, Cochrane Brazil, Universidade Federal de São Paulo, São Paulo, Brazil
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Alamshah SM, Zangeneh Yousefabadi E. How Diluted Liquid Sodium Tetradecyl Sulphate Works in Varices with Competent Superficial Valves Versus Stockings Alone. Pak J Biol Sci 2021; 23:1018-1024. [PMID: 32700852 DOI: 10.3923/pjbs.2020.1018.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Varicose veins are the most common complaints of referrals to vascular surgeons. Upon the cause, liquid sclerotherapy could be an efficient solution first in regard to competent main superficial valves. To find the impact of diluted liquid sclerotherapy in varices in patients with no superficial valve refluxes compare to whom wearing only stockings. MATERIALS AND METHODS Sclerotherapy with 0.3-0.5% liquid form of Sodium Tetradecyl Sulphate (STS) for reticular and spider varicosis, ulcers feeder veins and grade 3-4 sporadic varices were used. Patient's complaints the zone prevalence, response and satisfactoriness were detected clinically and data compared between the two injected cases and who managed by stockings alone with >1 year follow up. RESULTS Two groups (156 sclerotherapy, 76 only stockings) with three classifications for severity were obtained. Complete recovery of all varices and ulcers were almost achieved with no considerable complication. Logical regression test in unilateral to bilateral varices predict about 70% more recovery (p = 0.048), mild to severe 85% more (p<0.001), moderate to severe 29% more (p = 0.008) and 10-15% response for severe cases. No significant difference for ages and responses between the 2 groups was existed. CONCLUSION Diluted liquid sclerotherapy by STS was shown efficient in all ranges of varices. Stockings alone also were adequate to relief symptoms compare to sclerotherapy.
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Juan GMS, Yanggui XMS, Bo LMD, Xiaoqin QMD. Evaluating the Curative Effect of Ultrasound-guided Sclerotherapy with Foam Lauromacrogol for Uterine Fibroids. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.190030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Cebeci D, Karasel S, Yaşar Ş. Venous Lakes of the Lips Successfully Treated With a Sclerosing Agent 1% polidocanol: analysis of 25 report cases. Int J Surg Case Rep 2020; 78:265-269. [PMID: 33373920 PMCID: PMC7776749 DOI: 10.1016/j.ijscr.2020.12.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
Venous lake (VL) isa venous ectasia occurring on the lips in the elderly. Treatment of lip venous lake includes surgical excision, laser therapy, infrared coagulation, and cryotherapy. Sclerotherapy is an effective and acceptable option for treatment of venous lake lesions of the lips in patients.
Background Venous lakes of the lip is vascular ectasia that generally appears on the lower lip and other sun-damaged surfaces of skin in elderly patient. There are many local therapies for treatment of lip venous lake such as surgical excision, cryotherapy, infrared coagulation and laser therapy. Sclerotherapy as treatment is used in varicose veins, leg telangiectasia, hemorrhoids and hemangiomas but for lip venous lake only two case has been reported. Therefore, we managed this study to determine the efficacy of injection of 1% polidocanol in the treatment of venous lake lesions. Methods This is retrospective study. Twenty five adult patient presenting with several localizations of venous lake were enrolled in the study. Informed consent was given before the treatment and a photo of the venous lake was taken. After the lesion was cleaned with an antiseptic, was slowly injected 1% polidocanol into each patient's lesion, followed by compression for 5 min. Visual Analog Scale (VAS) scale was used to indicate patient satisfaction. Result Lesions were completely cleared in all patients after treatment. The lesions generally disappeared in two cases leaving an insignificant scar, in two cases become angioedema with two sessions of sclerotherapy. İn other cases side effects were not observed. Conclusion Sclerotherapy with polidocanol is an easy, inexpensive method and is found very effective in the treatment of lip venous lake. İn the future it offers an alternative to other classic methods.
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Affiliation(s)
- Dua Cebeci
- Famagusta State Hospital Dermatology and Venerology, Famagusta, Cyprus.
| | - Seide Karasel
- Famagusta State Hospital, Department of Physical Medicine and Rehabilitation, Famagusta, Cyprus
| | - Şirin Yaşar
- Haydarpaşa Numune Training and Research Hospital Dermatology and Venereology Department, İstanbul, Turkey
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Venous malformation of the foot: Spontaneous regression postpartum on MRI. Radiol Case Rep 2020; 16:62-65. [PMID: 33193930 PMCID: PMC7642758 DOI: 10.1016/j.radcr.2020.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
Venous malformations (VMs) are present at birth, grow proportionally during childhood, and usually do not regress. We report the imaging appearance of a VM of the foot found during pregnancy, which regressed spontaneously postpartum. A 35-year-old, 8-month-pregnant woman presented with a 6-month history of painful swelling of the left foot. MRI demonstrated a well-defined, intricate-shaped mass measuring 38 × 36 × 28 mm between the muscles and tendons of the third, fourth, and fifth toes with subcutaneous extension. Dynamic CT taken a month after delivery revealed gradual enhancement of the lesion. Gray-scale ultrasonography (US) showed a heterogenic hypoechoic mass containing thrombi with venous waveforms on Doppler US. A second MRI obtained 15 months after delivery showed a remarkable reduction of the lesion size (16 × 20 × 15 mm). Symptomatic VMs found during pregnancy can be observed conservatively without treatment.
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Meghdadi A, Jones SA, Patel VA, Lewis AL, Millar TM, Carugo D. Foam-in-vein: A review of rheological properties and characterization methods for optimization of sclerosing foams. J Biomed Mater Res B Appl Biomater 2020; 109:69-91. [PMID: 32621565 DOI: 10.1002/jbm.b.34681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022]
Abstract
Varicose veins are chronic venous defects that affect >20% of the population in developed countries. Among potential treatments, sclerotherapy is one of the most commonly used. It involves endovenous injection of a surfactant solution (or foam) in varicose veins, inducing damage to the endothelial layer and subsequent vessel sclerosis. Treatments have proven to be effective in the short-term, however recurrence is reported at rates of up to 64% 5-year post-treatment. Thus, once diagnosed with varicosities there is a high probability of a permanently reduced quality of life. Recently, foam sclerotherapy has become increasingly popular over its liquid counterpart, since foams can treat larger and longer varicosities more effectively, they can be imaged using ultrasound, and require lower amounts of sclerosing agent. In order to minimize recurrence rates however, an investigation of current treatment methods should lead to more effective and long-lasting effects. The literature is populated with studies aimed at characterizing the fundamental physics of aqueous foams; nevertheless, there is a significant need for appropriate product development platforms. Despite successfully capturing the microstructural evolution of aqueous foams, the complexity of current models renders them inadequate for pharmaceutical development. This review article will focus on the physics of foams and the attempts at optimizing them for sclerotherapy. This takes the form of a discussion of the most recent numerical and experimental models, as well as an overview of clinically relevant parameters. This holistic approach could contribute to better foam characterization methods that patients may eventually derive long term benefit from.
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Affiliation(s)
- Alireza Meghdadi
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | | | | | | | | | - Dario Carugo
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK.,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK
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Clinical outcome of short-term compression after sclerotherapy for telangiectatic varicose veins. J Vasc Surg Venous Lymphat Disord 2020; 9:435-443. [PMID: 32502730 DOI: 10.1016/j.jvsv.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sclerotherapy is considered to be the method of choice for the treatment of telangiectatic varicose veins (C1 veins). Whereas the use of compression stockings after sclerotherapy is recommended, little is known about the impact of compression on the outcome of sclerotherapy. The aim of this study was to assess the influence of compression on the outcome of injection sclerotherapy of C1 varicose veins. METHODS There were 100 legs of 50 consecutive patients with chronic venous insufficiency (C1) included. After randomization per patient, both legs were treated with sclerotherapy in a predefined area of the thigh (measuring 100 cm2), followed by eccentric compression for 24 hours. Group A received no further compression, whereas group B was additionally equipped with compression stockings of 18 to 20 mm Hg above the ankle and continued wearing these for 1 week. Photodocumentation was performed before, 1 week after, and 4 weeks after sclerotherapy, and the clinical outcome was assessed at these postprocedure follow-up dates. The photographs were reviewed by an internal unblinded rater and an independent blinded external rater. RESULTS There was no discernible difference between the groups in terms of clinical outcome or side effects after 4 weeks. Whereas inter-rater reliability was high, there was no correlation between the raters and patients in terms of outcome. In 55% of the treated legs, the patients deemed the result of the treatment to be good; in 27% of the treated legs, fair; and in 18%, poor. Postprocedure hyperpigmentation occurred in 13% of patients and was comparable in both groups. Compression therapy was found to be comfortable by the majority (58%) of patients. CONCLUSIONS One week of postinterventional compression therapy had no clinical benefit compared with no compression.
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Bottaro E, Paterson JAJ, Quercia L, Zhang X, Hill M, Patel VA, Jones SA, Lewis AL, Millar TM, Carugo D. In vitro and ex vivo evaluation of the biological performance of sclerosing foams. Sci Rep 2019; 9:9880. [PMID: 31285447 PMCID: PMC6614483 DOI: 10.1038/s41598-019-46262-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/21/2019] [Indexed: 11/09/2022] Open
Abstract
Since the first reports on foam sclerotherapy, multiple studies have been conducted to determine the physical properties and behavior of foams, but relatively little is known about their biological effects on the endothelial cells lining the vessel wall. Moreover, a systematic comparison of the biological performance of foams produced with different methods has not been carried out yet. Herein, a 2D in vitro method was developed to compare efficacy of commercially available polidocanol injectable foam (PEM, Varithena) and physician-compounded foams (PCFs). Endothelial cell attachment upon treatment with foam was quantified as an indicator of therapeutic efficacy, and was correlated with foam physical characteristics and administration conditions. An ex vivo method was also developed to establish the disruption and permeabilisation of the endothelium caused by sclerosing agents. It relied on the quantitation of extravasated bovine serum albumin conjugated to Evans Blue, as an indicator of endothelial permeability. In our series of comparisons, PEM presented a greater overall efficacy compared to PCFs, across the different biological models, which was attributed to its drainage dynamics and gas formulation. This is consistent with earlier studies that indicated superior physical cohesiveness of PEM compared to PCFs.
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Affiliation(s)
- Elisabetta Bottaro
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | | | - Luciano Quercia
- Computer Science Department, University of Bari, Bari, Italy
| | - Xunli Zhang
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
- Institue for Life Sciences (IfLS), University of Southampton, Southampton, UK
| | - Martyn Hill
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
- Institue for Life Sciences (IfLS), University of Southampton, Southampton, UK
| | - Venisha A Patel
- Biocompatibles UK Ltd., Lakeview, Riverside Way, Watchmoor Park, Camberley, UK
| | - Stephen A Jones
- Biocompatibles UK Ltd., Lakeview, Riverside Way, Watchmoor Park, Camberley, UK
| | - Andrew L Lewis
- Biocompatibles UK Ltd., Lakeview, Riverside Way, Watchmoor Park, Camberley, UK
| | - Timothy M Millar
- Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Dario Carugo
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK.
- Institue for Life Sciences (IfLS), University of Southampton, Southampton, UK.
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Dos Santos JB, Júnior WC, Porta RM, Puggina J, da Silva DF, Puech-Leão P, de Luccia N, da Silva ES. Catheter-directed foam sclerotherapy with tumescence of the great saphenous vein versus ultrasound-guided foam sclerotherapy: A randomized controlled trial. Phlebology 2019; 35:84-91. [PMID: 31117882 DOI: 10.1177/0268355519850651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To compare the effectiveness of two foam sclerotherapy techniques of the great saphenous vein. Methods Fifty subjects with varicose veins, edema, and great saphenous vein incompetence (diameter 6–10 mm) were randomly categorized into two equal groups and were treated with different foam sclerotherapy techniques: A (usual ultrasound-guided) and B (catheter-directed with tumescence). Concomitant phlebectomy was performed in all patients. Patients were seen on days 7 and 28, and at six and 12 months. The primary outcomes were the full success rate of the treated great saphenous vein and the number of patients who required retreatment sessions performed at 28-day follow-up. The secondary-assisted outcomes were the full success rates of the treated great saphenous vein after the retreatment sessions at six- and 12-month follow-up. Secondary outcomes were changes in quality of life and side effects and complications of the intervention. In case of reflux, retreatment sessions were performed at 28 days and six months in both groups. Results Full success rate of the treated great saphenous vein was 36% in group A vs. 80% in group B ( p = 0.012) and the number of patients who required retreatment sessions were n = 14 in group A vs. n = 3 in group B at 28-day follow-up ( p = 0.002). Both were statistically significant. At six and 12 months, the success rates were not statistically significant between the groups. Complication rates were similar between the groups. Quality of life improved in both groups with statistical difference ( p < 0.001). Conclusions Catheter-directed foam sclerotherapy with tumescence was better than usual ultrasound-guided foam sclerotherapy as it reached higher full success rate of the treated great saphenous vein and as a lower number of patients required retreatment sessions in the short-term. Both methods proved to be safe and improved the quality of life.
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Affiliation(s)
- Jorgete B Dos Santos
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Walter Campos Júnior
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Rina Mp Porta
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Juliana Puggina
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Daniela Ft da Silva
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho/UNINOVE, São Paulo, Brazil
| | - Pedro Puech-Leão
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Nelson de Luccia
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Erasmo S da Silva
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
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Wang JC, Li Y, Li GY, Xiao Y, Li WM, Ma Q, Liu JL, Lu SY. A Comparison of Concomitant Tributary Laser Ablation and Foam Sclerotherapy in Patients Undergoing Truncal Endovenous Laser Ablation for Lower Limb Varicose Veins. J Vasc Interv Radiol 2018; 29:781-789. [DOI: 10.1016/j.jvir.2018.01.774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/20/2017] [Accepted: 01/16/2018] [Indexed: 10/17/2022] Open
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Gong X, Zhou Q, Chen S, Wang F, Wu W, Chen X. Efficacy and safety of ultrasound-guided percutaneous polidocanol sclerotherapy in benign predominantly cystic thyroid nodules: a prospective study. Curr Med Res Opin 2017; 33:1505-1510. [PMID: 28466660 DOI: 10.1080/03007995.2017.1325732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of percutaneous polidocanol injection (PPI) in treatment of predominantly cystic thyroid nodules. MATERIALS AND METHODS This prospective study included 111 patients with 122 benign predominantly cystic thyroid nodules inducing pressure symptoms or cosmetic problems. The nodules were randomized to a single aspiration with (n = 61) or without (n = 61) subsequent PPI and followed up after 1, 3, 6, and 12 months. Ten patients (12 nodules) declined to follow up after aspiration in group 2. Nodule volumes, symptoms scores, and cosmetic scores were evaluated before and after treatment. The therapeutic success rate and safety of PPI for treatment of predominantly cystic thyroid nodules were also evaluated. RESULTS In the PPI group, the nodule volumes were reduced from 13.67 ± 9.90 to 2.60 ± 2.66 (p < .001). Therapeutic success rate (nodule volume reduction >50%) was obtained in 57 of 61 (93.44%) nodules in the PPI group, compared to seven of 49 (14.29%) in the aspiration group (p < .001). In the aspiration group, the nodule volume was not significantly reduced. The reduction in symptom scores was significantly higher in the PPI group (from 3.60 ± 1.65 to 1.60 ± 1.19) than in the aspiration group (from 3.62 ± 1.89 to 3.30 ± 1.06) (p < .001, between groups). The reduction in cosmetic scores showed a significant difference between groups (p < .001). In total, 4.92% of patients (3/61) in the PPI group and 85.71% (42/49) in the aspiration group showed recurrence during the follow-up period. There was a significant difference in the recurrence rate between groups (p < .001). No major side-effects occurred. CONCLUSIONS US-guided PPI of benign recurrent predominantly cystic thyroid nodules is effective and safe. PPI is an important alternative to benign recurrent predominantly cystic thyroid nodules.
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Affiliation(s)
- Xiaohua Gong
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Qi Zhou
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Shuoping Chen
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Fang Wang
- b Department of Pathology , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Wenjun Wu
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
| | - Xiaojun Chen
- a Department of Endocrinology and Metabolism , the First Affiliated Hospital of Wenzhou Medical University , Ouhai District , Wenzhou 325015 , Zhejiang Province , PR China
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Trivedi MK, Kroumpouzos G, Murase JE. A review of the safety of cosmetic procedures during pregnancy and lactation. Int J Womens Dermatol 2017; 3:6-10. [PMID: 28492048 PMCID: PMC5418954 DOI: 10.1016/j.ijwd.2017.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/21/2017] [Accepted: 01/21/2017] [Indexed: 01/21/2023] Open
Abstract
The safety of cosmetic procedures in patients who are pregnant and/or lactating is a complex clinical question surrounded by uncertainty. Our objective is to consolidate data on the safety of commonly requested cosmetic procedures during pregnancy and lactation after a systematic review of the current literature to guide evidence-based care in the future. A systematic search of the PubMed database was conducted for articles on cosmetic procedures during pregnancy and lactation. Due to a lack of controlled trials, case reports and series were considered. Minor procedures such as shave, punch, snipping, and electrocautery are considered safe. With respect to chemical peels, glycolic and lactic acid peels are deemed safe; however, trichloracetic and salicylic acid peels should be avoided or used with caution. Although safety data on botulinum toxin A is insufficient, the procedure may be safe because systemic absorption and placental transfer are negligible. Sclerotherapy can be safe during pregnancy but must be avoided during the first trimester and after week 36 of the pregnancy. Laser and light therapies have been considered generally safe for patients with granulomatous conditions and condylomata. Epilation should be limited to waxing, shaving, and topical treatments instead of permanent procedures. In patients who are lactating, most therapies discussed above are safe but fat transfer, sclerotherapy, and tumescent liposuction are not recommended. Better evidence is needed to make concrete recommendations on the safety of cosmetic therapy during pregnancy and lactation but preliminary evidence suggests excellent safety profiles for many commonly requested cosmetic procedures.
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Affiliation(s)
- M K Trivedi
- Department of Dermatology, University of California San Francisco, San Francisco, California.,University of Michigan Medical School, Ann Arbor, Michigan
| | - G Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - J E Murase
- Department of Dermatology, University of California San Francisco, San Francisco, California.,Department of Dermatology, Palo Alto Medical Foundation, Mountain View, California
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Malagón Reyes RM, Castorena de Ávila R, Ángeles Vázquez MDJ, Núñez Monteagudo CA, Mendieta Zerón H. Sclerotherapy with 6% polidocanol solution in patients with placenta accreta. Taiwan J Obstet Gynecol 2016; 55:654-658. [DOI: 10.1016/j.tjog.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 10/20/2022] Open
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17
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Carugo D, Ankrett DN, O'Byrne V, Wright DDI, Lewis AL, Hill M, Zhang X. The role of clinically-relevant parameters on the cohesiveness of sclerosing foams in a biomimetic vein model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:258. [PMID: 26449448 PMCID: PMC4598354 DOI: 10.1007/s10856-015-5587-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/25/2015] [Indexed: 06/05/2023]
Abstract
We have recently reported on the development of a biomimetic vein model to measure the performance of sclerosing foams. In this study we employed the model to compare the commercially-available Varithena(®) (polidocanol injectable foam) 1% varicose vein treatment (referred to as polidocanol endovenous microfoam, or PEM) with physician compounded foams (PCFs) made using different foam generation methods (Double Syringe System and Tessari methods) and different foam formulations [liquid to gas ratios of 1:3 or 1:7; gas mixtures composed of 100% CO2, various CO2:O2 mixtures and room air (RA)]. PCFs produced using the DSS method had longer dwell times (DTs) (range 0.54-2.21 s/cm in the 4 mm diameter vein model) than those of the corresponding PCFs produced by the Tessari technique (range 0.29-0.94 s/cm). PEM had the longest DT indicating the best cohesive stability of any of the foams produced (2.92 s/cm). Other biomimetic model variables investigated included effect of vessel size, delayed injection and rate of plug formation (injection speed). When comparing the 4 and 10 mm vessel diameters, the DTs seen in the 10 mm vessel were higher than those observed for the 4 mm vessel, as the vein angle had been reduced to 5° to allow for foam plug formation. PCF foam performance was in the order RA > CO2:O2 (35:65) ≅ CO2:O2 (65:35) > CO2; PEM had a longer DT than all PCFs (22.10 s/cm) except that for RA made by DSS which was similar but more variable. The effect of delayed injection was also investigated and the DT for PEM remained the longest of all foams with the lowest percentage deviation with respect to the mean values, indicating a consistent foam performance. When considering rate of plug formation, PEM consistently produced the longest DTs and this was possible even at low plug expansion rates (mean 29.5 mm/s, minimum 20.9 mm/s). The developed vein model has therefore demonstrated that PEM consistently displays higher foam stability and cohesiveness when compared to PCFs, over a range of clinically-relevant operational variables.
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Affiliation(s)
- Dario Carugo
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, SO17 1BJ, UK
- Electro-Mechanical Engineering Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, SO17 1BJ, UK
| | - Dyan N Ankrett
- Electro-Mechanical Engineering Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, SO17 1BJ, UK
| | - Vincent O'Byrne
- Biocompatibles UK Ltd. A BTG International Group Company, Farnham Business Park, Weydon Lane, Farnham, Surrey, GU9 8QL, UK
| | | | - Andrew L Lewis
- Biocompatibles UK Ltd. A BTG International Group Company, Farnham Business Park, Weydon Lane, Farnham, Surrey, GU9 8QL, UK.
| | - Martyn Hill
- Electro-Mechanical Engineering Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, SO17 1BJ, UK
- Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Xunli Zhang
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, SO17 1BJ, UK
- Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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Lee KC, Korgavkar K, Dufresne RG, Higgins WH. Safety of Cosmetic Dermatologic Procedures During Pregnancy. Dermatol Surg 2013; 39:1573-86. [DOI: 10.1111/dsu.12322] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Mueller RL, Raines JK. ClariVein mechanochemical ablation: background and procedural details. Vasc Endovascular Surg 2013; 47:195-206. [PMID: 23509062 DOI: 10.1177/1538574413477216] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The 2 primary objectives of this publication are to provide a practical step-by-step procedure for the ClariVein system and a focused literature review of endovenous ablation. MATERIALS AND METHODS The ClariVein system is the first venous ablation technique to employ a hybrid (dual-injury) technique built into 1 catheter-based delivery system. Endomechanical abrasion is produced by the tip of the catheter's rotating wire (mechanical component); and endovenous chemical ablation (EVCA) is via simultaneous injection of sclerosant over the rotating wire (chemical component). The author is an early adopter of this technique and via experience has developed a detailed step-by-step protocol. DISCUSSION To date, there have been 2 pivotal clinical studies published using the ClariVein system. These data are compared with the results using other methods of endovenous ablation. CONCLUSIONS The ClariVein system is an exciting addition to the phlebologist's toolbox and has the potential to become a first-line treatment.
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Abstract
ZusammenfassungDie Anwendung von Aethoxysklerol® in aufgeschäumter Form ist in Deutschland seit 2009 als Behandlungsoption der Varikose zugelassen. Entsprechend der aktuellen Leitlinien ist sie grundsätzlich für alle Formen der Varikose geeignet. Besonders bewährt hat sie sich in der Behandlung der Seitenastvarikose und Perforantes sowie als nicht-operative Alternative bei der Stammvarikose. Voraussetzung für die Planung und Durchführung der Schaumsklerosierungstherapie ist neben Anamnese und klinischer Untersuchung eine sorgfältige Duplexsonographie am stehenden Patienten zur Erstellung eines Venenmappings. Ist die Indikation und Entscheidung zur Sklerosierungstherapie gefallen, so muss der Patient sorgfältig informiert werden und schriftlich der Behandlung zustimmen.Für die Punktion der Varize sollte der Patient stehen oder sitzen, alternativ kann er bei gut sichtbaren Varizen oder duplexkontrollierter Direktpunktion auch liegen. Die Applikation des Sklerosierungsmittels sollte immer im Liegen erfolgen. Für die Schaumherstellung haben sich das Tessari- und das DSS-System bewährt. Nach der Injektion des Schaums sollten eine exzentrische Kompression, ein lokaler Kompressionsverband und anschließend eine Kompression mittels Kompressionsstrumpf erfolgen.Die Nebenwirkungen der Schaumsklerosie-rung unterscheiden sich nicht wesentlich von denen der Flüssigsklerosierung. Zur Verlaufskontrolle eignet sich die Duplexsonographie.
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Abstract
Recently published evidence-based guidelines of the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) include recommendations for evaluation, classification, outcome assessment and therapy of patients with varicose veins and more advanced chronic venous insufficiency (CVI). The need for such guidelines has been evident since imaging techniques and minimally invasive technologies have progressed by leaps and bounds and radiofrequency ablation, laser and sclerotherapy have largely replaced classical open surgery of saphenous stripping. This report reviews the most important guidelines recommended by the SVS/AVF Venous Guideline Committee. It is obvious, however, that some of the technology that is recommended in North America is either not available or not affordable in some parts of the world for patients with varicose veins and CVI. The readers are urged therefore to also consult the guidelines of their national societies, recent publications of the National Institute for Clinical Excellence and the Venous Forum of the Royal Society of Medicine. Venous specialists should also keep in mind that scientific evidence should always be combined with the physician's clinical experience and the patient's preference when the best treatment is selected for an individual patient.
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Affiliation(s)
- P Gloviczki
- Division of Vascular and Endovascular Surgery, 200 First Street SW, Mayo Clinic, Rochester, MN 55905, USA.
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Comparative Stability of Sodium Tetradecyl Sulphate (STD) and Polidocanol Foam: Impact on Vein Damage in an In-vitro Model. Eur J Vasc Endovasc Surg 2012; 43:721-5. [DOI: 10.1016/j.ejvs.2012.02.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 02/23/2012] [Indexed: 11/17/2022]
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Abstract
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.
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Affiliation(s)
- Margaret W Mann
- Department of Dermatology, University of California, C340 Medical Sciences I, Irvine, CA 92697, USA.
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