RESUMEN
BACKGROUND AND OBJECTIVE: Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs. METHODS: This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym). RESULTS: Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy. CONCLUSION: Both polidocanol foam sclerotherapy and conventional surgery positively impact patients' quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.
Asunto(s)
Calidad de Vida , Várices , Humanos , Polidocanol , Polietilenglicoles , Estudios Prospectivos , Vena Safena , Soluciones Esclerosantes/uso terapéutico , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Resultado del Tratamiento , Várices/cirugía , Várices/terapiaRESUMEN
BACKGROUND: Cryo-Laser & Cryo-Sclerotherapy (CLaCS) is a technique which combines thermal sclerotherapy and injection sclerotherapy. Telangiectasias and small varicosities are targeted by a transdermal laser and right after receive injection sclerotherapy. A cooling device blows -20°C air onto the skin and needle in a pre-, parallel-, and post-fashion. OBJECTIVE: Our objective was to establish if there is a difference in result and complications by varying the sclerosing agent but keeping the same ND:Yag long pulse laser parameters in the treatment of small varicosities. METHODS: Fifty five patients were enrolled prospectively and randomized to two groups; in the group 1 dextrose 75% was the sclerosing agent used in combination with the ND:Yag long pulse laser and, in the group 2, the same laser technique was used but the sclerosing agent was polidocanol 0.3% and dextrose 67%. RESULTS: The results were evaluated 30 days after the treatment by the patients and for blinded evaluators using before and after standardized photos with and without augmented reality. In the patient's perspective and in the blinded evaluation of the regular photos, no differences between the groups were found. Both groups had low rates of hyperpigmentation and bruising with no statistical difference. Patients treated with polidocanol had less pain after the treatment and a better clearance rate in the photos with augmented reality. No major complications were found. CONCLUSION: The treatment of small varicosities with CLaCS using Dextrose 75% or polidocanol 0.3% and Dextrose 67.5% is a safe and effective procedure and both sclerosing agents can be used with similar results. Possibly, in the polidocanol group more nonvisible reticular veins were cleared, but the implication of this find is not clear.
Asunto(s)
Terapia por Láser , Láseres de Estado Sólido , Telangiectasia , Várices , Humanos , Soluciones Esclerosantes/uso terapéutico , Escleroterapia/métodos , Polidocanol , Láseres de Estado Sólido/uso terapéutico , Resultado del Tratamiento , Terapia por Láser/métodos , Telangiectasia/cirugía , Várices/terapia , Polietilenglicoles , Glucosa/uso terapéuticoRESUMEN
Sodium lauryl sulfate is the main cleaning ingredient in shampoos, even though it may be potentially damaging to hair. The demand for antioxidant-rich cosmetics, on the other hand, has encouraged green cosmetics research. Brazil has vast biodiversity that can be exploited for the production of these cosmetics. This work aimed to develop a minimalist antioxidant lauryl-free shampoo formulation with leaf extracts from the Brazilian plant Hancornia speciosa Gomes. Two hydroethanolic extracts were prepared using different extraction methods, Soxhlet, and ultrasound. The extracts were characterized by the presence of saponins, polyphenol quantification, and HLPC chemical identification of the compounds. Antioxidant activity was determined using the DPPH method. The antioxidant lauryl-free shampoo was developed using hydroxyethyl cellulose with two concentrations of leaf extract obtained by Soxhlet, 0.125 mg/g (XP1) and 0.250 mg/g (XP2). Along with the antioxidant activity, the physical and chemical properties, cleaning potential, and foam quality were evaluated. The Soxhlet leaf extract revealed a more favorable chemical profile, including a positive result for saponins, as well as a larger quantity of polyphenols and increased antioxidant activity. The XP2 formulation showed better foam height, dirt dispersion, and antioxidant activity. Thus, the use of mangabeira leaf extract appears to be promising for the development of shampoos with antioxidant activity.
O lauril sulfato de sódio é o principal ingrediente de limpeza em xampus, embora possa ser potencialmente prejudicial ao cabelo. A demanda por cosméticos ricos em antioxidantes, por outro lado, tem incentivado as pesquisas com cosméticos verdes. O Brasil possui uma vasta biodiversidade que pode ser explorada para a produção desses cosméticos. O objetivo deste trabalho foi desenvolver uma formulação de xampu antioxidante minimalista sem lauril com extratos de folhas da planta brasileira Hancornia speciosa Gomes. Dois extratos hidroetanólicos foram preparados usando diferentes métodos de extração, Soxhlet e ultrassom. Os extratos foram caracterizados quanto à presença de saponinas, quantificação de polifenóis e identificação química HLPC dos compostos. A atividade antioxidante foi determinada pelo método DPPH. O xampu antioxidante sem lauril foi desenvolvido utilizando hidroxietil celulose com duas concentrações de extrato de folha obtido por Soxhlet, 0.125 mg/g (XP1) e 0.250 mg/g (XP2). Juntamente com a atividade antioxidante, foram avaliadas as propriedades físicas e químicas, potencial de limpeza e qualidade da espuma. O extrato da folha de Soxhlet revelou um perfil químico mais favorável, incluindo resultado positivo para saponinas, além de maior quantidade de polifenóis e aumento da atividade antioxidante. A formulação XP2 apresentou melhor altura de espuma, dispersão de sujeira e atividade antioxidante. Assim, o uso do extrato da folha de mangabeira parece ser promissor para o desenvolvimento de xampus com atividade antioxidante.
Asunto(s)
Extractos Vegetales/farmacología , Cosméticos , Apocynaceae , Polidocanol , Antioxidantes , BrasilRESUMEN
INTRODUCTION: The aneurysmal bone cyst is a rare benign but aggressive osteolytic tumor for which there is still no ideal treatment, the reports on treatment by sclerotherapy in the pediatric population are scarce and in our region even less. The objective is to communicate the experience of the treatment of aneurysmal bone cyst with polydocanol 3%. MATERIAL Y METHODS: Retrospective, descriptive and cross-sectional study. Period: June/2017 to June/2021. Inclusion: patients with histological diagnosis of aneurysmal bone cyst; Under general anesthesia and fluoroscopic guidance, intralesional puncture with 16G needle was performed through which 3% polydocanol was slowly administered. Data: medical history. Quantitative variables shall be expressed in measures of central tendency and dispersion; qualitative variables shall be expressed as frequencies or percentages. RESULTS: Nine consecutive patients were included, all of whom had pain and tumor in one of the extremities. Gender: 3 female and 6 male. Age: median 10.5 years (range: 2-15.1). Weight: median 32.8 kg (range: 11-44.5). Total procedures: 44; procedures per patient: mean 4.9 (SD: ± 2.0). Procedure time: mean 33.9 minutes (SD: ± 18.3); radiation: mean 1.34 mGy (SD: ± 1.55). Hospitalization: one day, except one patient. Complications: skin damage in one case, no recurrences follow-up: 12 to 50 months. CONCLUSION: In this pediatric series, polydocanol 3% was useful and effective for the treatment of aneurysmal bone cyst, with few complications. One disadvantage is that it requires several sessions and in addition, no significant difference has been demonstrated between other forms of treatment in terms of the recurrence rate.
INTRODUCCIÓN: El quiste óseo aneurismático es un raro tumor osteolítico benigno, pero agresivo para el que aún no existe tratamiento ideal. Los comunicados sobre tratamiento mediante escleroterapia en población pediátrica son escasos y en nuestra región más aún. El objetivo es comunicar la experiencia del tratamiento del quiste óseo aneurismático con polidocanol 3%. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo y transversal. Período: Junio de 2017 a Junio de 2021. Inclusión: pacientes con diagnóstico histológico de quiste óseo aneurismático. Bajo anestesia general y guía fluoroscópica se realizó punción intralesional con aguja 16G a través de la cual se administró lentamente el polidocanol 3%. Datos: historia clínica. Las variables cuantitativas se expresarán en medidas de tendencia central y de dispersión; las variables cualitativas se expresarán como frecuencias o porcentajes. RESULTADOS: Se incluyeron nueve pacientes consecutivos, todos presentaban dolor y tumoración en alguna de las extremidades. Género: tres femeninos y seis masculinos. Edad: mediana 10.5 años (rango: 2-15.1). Peso: mediana 32.8 kg (rango: 11-44.5). Total de procedimientos: 44, procedimientos por paciente: promedio 4.9 (DE: ± 2.0). Tiempo de procedimiento: promedio 33.9 minutos (DE: ± 18.3); radiación: promedio 1.34 mGy (DE: ± 1.55). Hospitalización: un día, excepto un paciente. Complicaciones: Daño de piel en un caso, no recidivas. Seguimiento: de 12 a 50 meses. CONCLUSIÓN: En esta serie pediátrica el polidocanol 3% fue útil y efectivo para el tratamiento del quiste óseo aneurismático con escasas complicaciones. Una desventaja es que requiere varias sesiones y además, no se ha demostrado una diferencia significativa entre otras formas de tratamiento en términos de la tasa de recurrencia.
Asunto(s)
Quistes Óseos Aneurismáticos , Adolescente , Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/terapia , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Uso Fuera de lo Indicado , Polidocanol/uso terapéutico , Estudios RetrospectivosRESUMEN
OBJECTIVE: To compare the efficacy and safety of sclerosing agents injected in dorsal veins of rabbit ears. METHODS: Sixty ears of 30 rabbits were randomly allocated in: 1% liquid polidocanol, 1% polidocanol foam, 0.2% polidocanol-glucose 70% solution, glucose 75% or 0.9% saline. Outcomes included efficacy (luminal occlusion), complications (phlebitis, neovascularization, ulceration at the puncture site, necrosis and local inflammation) and histology (sclerosis, recanalization vein and surrounding tissues inflammation, blood extravasation, recanalization, lymphangiogenesis, destruction of cartilage and neoangiogenesis). RESULTS: Sclerosis was superior in Foam Group (76.9%), but also with 30.7% necrosis (p = 0.003), 46.15% ulceration (p = 0.003), and 69.2% local inflammation (p < 0.0001). Neovascularization were similar. Histology showed 38.5% phlebitis (p = 0.004) and necrosis (p = 0.03) in the foam group. CONCLUSIONS: Sclerosis with foam and liquid polidocanol were superior to the other groups, but specially polidocanol foam at the expense of greater frequency of adverse events.
Asunto(s)
Glucosa , Escleroterapia , Animales , Conejos , Polidocanol , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Resultado del TratamientoRESUMEN
OBJECTIVE: Sclerotherapy for the treatment of varicose veins is one of the most common medical procedures performed in the Western world, and hyperpigmentation is one of the most frequent, dreaded, minor adverse events. There has recently been some interest in investigating the inflammatory response of the local endothelium after sclerotherapy and the possible benefits of venoactive drugs because of their pleiotropic properties. The aim of this study was to evaluate whether adding a venoactive drug (sulodexide) to the standard sclerotherapy treatment protocol for patients with varicose veins can reduce the occurrence of postsclerotherapy hyperpigmentation. METHODS: We carried out a prospective, multicenter, randomized controlled trial with a parallel group design. It included 720 patients with telangiectasia, reticular veins, or varicose veins who were candidates for sclerotherapy. Patients with reflux in deep system or saphenous veins were excluded. Group A consisted of 354 patients who received an oral dose of sulodexide twice a day for 7 days before scheduled sclerotherapy; the treatment then continued for 3 months. Group B consisted of 366 patients who received the standard sclerotherapy protocol. Polidocanol was used as the sclerosing agent, and 20 to 30 mm Hg compression stockings were used in both groups for 7 days. Control photographs were taken, and a follow-up examination took place after 1 month and 3 months. Computer software was used to analyze the treated area for incidence of hyperpigmentation, total area of hyperpigmentation, skin tone increase in the hyperpigmented area, vein disappearance, and incidence of major bleeding. The sample size was calculated to give a statistical power of 80%. Student t-test and the χ2 test were used for comparative analyses, as appropriate. The level of significance was set at P < .05. RESULTS: A total of 609 patients completed the 3-month follow-up: 312 in group A and 297 in group B. After 1 month, the incidence of hyperpigmentation was 8.7% in group A and 14.8% in group B (P = .01). Group A developed an average area of hyperpigmentation of 10.7% compared with 18.2% in group B (P = .01), and the skin tone of the hyperpigmented area was lower in group A than in group B (P = .02). However, the latter difference was not significant after 3 months. The overall vein disappearance rate was similar in both groups. CONCLUSIONS: Our analysis shows that by adding a venoactive drug (sulodexide) to the standard sclerotherapy protocol, the occurrence of hyperpigmentation is reduced without affecting the desired therapeutic vein elimination response.
Asunto(s)
Glicosaminoglicanos/uso terapéutico , Hiperpigmentación/prevención & control , Polidocanol/efectos adversos , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Pigmentación de la Piel/efectos de los fármacos , Telangiectasia/terapia , Várices/terapia , Adulto , Femenino , Glicosaminoglicanos/efectos adversos , Humanos , Hiperpigmentación/diagnóstico , Hiperpigmentación/etiología , Masculino , México , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Resumo Contexto A insuficiência venosa crônica é uma entidade com alta prevalência. Os casos avançados apresentam morbidade elevada. Objetivos Avaliar os riscos e benefícios da escleroterapia com espuma de polidocanol em pacientes que foram submetidos ao tratamento das veias safenas magnas bilateralmente em tempo único. Métodos Foram revistos retrospectivamente 55 pacientes (110 membros) portadores de incompetência bilateral das veias safenas magnas submetidas a tratamento escleroterápico com espuma bilateralmente, em tempo único, usando uma dose máxima de 20 mL de espuma de polidocanol por paciente. Resultados Das 110 safenas analisadas, obteve-se a oclusão de 81 (73,6%) com uma sessão, de 106 (96,3%) com duas sessões e de 110 (100%) com três sessões. Houve oclusão bilateral das safenas magnas em 27 pacientes (50%) em uma sessão, em 34 (62%) em duas sessões e em 55 (100%) em três sessões. De 11 pacientes portadores de úlceras, houve cicatrização total de sete (63%) e parcial de três (27%) 42 dias após a escleroterapia. Houve lipotimia autolimitada e escotomas visuais em um paciente (1,8%) e manchas em três (5,45%); 19 pacientes (34,5%) foram submetidos a punção para drenagem de coágulo retido. Conclusões A escleroterapia com espuma de polidocanol em veias safenas magnas em tempo único mostrou-se uma técnica segura e eficaz em pacientes selecionados.
Abstract Background Chronic venous insufficiency is a highly prevalent disease. Advanced cases have high morbidity. Objectives To evaluate the risks and benefits of foam sclerotherapy in patients who underwent bilateral treatment of the great saphenous veins in a single procedure, in selected cases of advanced venous insufficiency. Methods We retrospectively reviewed 55 patients (110 limbs) with bilateral incompetence of the great saphenous veins who had undergone foam sclerotherapy treatment bilaterally, using a maximum dose of 20 ml of foam per patient and inelastic compression. Results In 81 (73.6%) of the 110 saphenous veins analyzed, occlusion was obtained in the first session. After a second session this figure rose to 106 (96.3%) and all 110 (100%) veins were occluded after three sessions. Bilateral occlusion of the great saphenous veins was achieved in 27 patients (50%) in one session, in 34 (62%) patients in two sessions, and in 55 (100%) patients in three sessions. At 42 days after sclerotherapy, there was complete ulcer healing in seven (63%) of the 11 patients with ulcers and partial healing in 3 (27%) of these patients. One patient (1.8%) had self-limited lipothymia and visual scotomas, 3 patients (5.45%) had skin spots, and 19 patients (34.5%) developed retained intravascular coagulum. Conclusions Bilateral foam sclerotherapy in a synchronous procedure is an option to be considered for treatment of varicose veins of the lower limbs.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Vena Safena/fisiopatología , Escleroterapia/instrumentación , Polidocanol/uso terapéutico , Várices/terapia , Insuficiencia Venosa , Escleroterapia/métodos , Evaluación de Resultados de Intervenciones TerapéuticasRESUMEN
Insuficiencia venosa es definida como la patología que causa síntomas en los miembros inferiores, incluyendo edema, hiperpigmentación, lipodermatoesclerosis y ulceración e implica una anormalidad funcional del sistema venoso. Objetivo: Se compararon los resultados en cuanto a complicaciones y satisfacción reportada por las pacientes, con la Escleroterapia con Polidocanol utilizando aire y agua como diluyente. Métodos: Se incluyeron en el estudio a 60 pacientes del sexo femenino con diagnóstico de Insuficiencia Venosa Superficial CEAP C1, divididas en dos grupos, a las cuales se les aplicó Escleroterapia con Polidocanol mezclado con agua y aire. Se realizó seguimiento durante cuatro semanas donde se recogió la información del paciente con respecto a la mejoría de los síntomas antes de iniciar el tratamiento y los efectos adversos del Polidocanol con ambas terapias. Resultados: Dentro de las complicaciones de ambos tratamientos únicamente fue reportado el Matting en rango leve durante la primera semana. El único síntoma reportado como severo fue Dolor en la escleroterapia con polidocanol mezclado con aire. Los demás signos síntomas fueron reportados dentro del rango de moderado el cual descendió hasta leve entre la segunda y tercera semana, no encontrando reportes a la cuarta semana. La única complicación reportada fue el Matting en la escleroterapia con polidocanol mezclado con aire. Conclusión: No se encontraron diferencias significativas en grado de satisfacción con la eficacia del tratamiento, los efectos adversos, la forma en que se administra el medicamento entre ambos tratamientos de escleroterapia, oscilando los rangos de satisfacción entre el 43 al 70%. (AU)
Venous insufficiency is defined as the pathology that causes symptoms in the lower limbs, including edema, hyperpigmentation, lipodermatosclerosis and ulceration and implies a functional abnormality of the venous system. Objective: The results in terms of complications and satisfaction reported by the patients were compared with Sclerotherapy with Polidocanol using air and water as diluent. Methods: 60 female patients with a diagnosis of Superficial Venous Insufficiency CEAP C1 were included in the study, divided into two groups, to which Sclerotherapy with Polidocanol mixed with water and air was applied. A follow-up was carried out for four weeks where information from the patient was collected regarding the improvement of symptoms before starting treatment and the adverse effects of Polidocanol with both therapies. Results: Within the complications of both treatments, only Matting was reported in a mild range during the first week. The only symptom reported as severe was pain in sclerotherapy with polidocanol mixed with air. The other signs and symptoms were reported within the moderate range, which decreased to mild between the second and third week, finding no reports at the fourth week. The only complication reported was Matting in sclerotherapy with polidocanol mixed with air. Conclusion: No significant differences were found in the degree of satisfaction with the efficacy of the treatment, the adverse effects, the way in which the drug is administered between both sclerotherapy treatments, the satisfaction ranges ranging from 43 to 70%. (AU)
Asunto(s)
Humanos , Femenino , Soluciones Esclerosantes/uso terapéutico , Insuficiencia Venosa/terapia , Escleroterapia/métodos , Polidocanol/uso terapéutico , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Resultado del Tratamiento , Hiperpigmentación/inducido químicamente , Extremidad Inferior/irrigación sanguínea , Polidocanol/efectos adversosRESUMEN
Resumo A formação de linfocele, resultante da transecção dos canais linfáticos durante procedimentos cirúrgicos ou traumas, é relativamente comum, sendo relatada em aproximadamente 30% dos pós-operatórios de ressecção de linfonodos. Ela pode evoluir assintomática ou pode apresentar complicações, como dor, infecção secundária, compressão de vasos sanguíneos, a qual evolui para estase, trombose e edema. Seu tratamento ainda é de difícil consenso. Este artigo propõe descrever três casos em que o tratamento foi realizado a partir de ecoescleroterapia com polidocanol. Sua relevância está na escassez de relatos na literatura.
Abstract Formation of lymphocele secondary to transection of lymphatic channels during surgical procedures or traumas is relatively common and is reported in the postoperative period of approximately 30% of lymph node resection procedures. The condition may be asymptomatic or can present with complications such as pain, secondary infection, and compression of blood vessels, which can cause stasis, thrombosis, and edema. There is no consensus on treatment. This article describes three cases in which treatment was provided using polidocanol echosclerotherapy. Its relevance lies in the scarcity of reports in the literature.
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Linfocele/terapia , Escleroterapia/métodos , Polidocanol/uso terapéutico , Periodo Posoperatorio , Escleroterapia/instrumentación , Vasos Linfáticos/lesiones , EdemaRESUMEN
El hemangioma, según la Organización Mundial de la Salud (OMS), es una neoplasia vascular benigna, caracterizada por la proliferación anormal de vasos sanguíneos, se presenta como una lesión única, pudiéndose observar en cualquier parte del organismo, sin embargo es más incidente en el área de cabeza y cuello, con predominio en los labios, en la lengua y en la mucosa yugal. Técnicamente, su exrpación quirúrgica es dicil y desafiante, al estar cargada con complicaciones como hemorragia, escisión incompleta, desfiguración facial y recurrencia. Objevo: relatar el caso clínico de un paciente con hemangioma lingual tratado con Polidocanol al 0,5%. Se necesitaron de 4 sesiones de aplicación del agente esclerosaste para que retrocediera completamente la lesión donde en cada infiltración se ulizó 1ml y en la úlma sesión 0.7 ml, logrando en esta úlma obtener la desaparición de la lesión por lo que el pronósco fue bueno. Conclusión: De acuerdo a los resultados de este trabajo el uso del Polidocanol al 0.5% en tratamientos de hemangioma linguales resulta ser una técnica bastante efecva, ya que con su prácca nos da una disminución del volumen de dicha lesión
The hemangioma, according to theWorldHealthOrganizaon (WHO), is a benign vascular neoplasm, characterized by the abnormal proliferaon of blood vessels, it presents as a single lesion, it can be found anywhere in the body, however it is more incident in thearea of the head and neck, predominantlyonthelips, onthetongue and onthejugal mucosa. Technically, its surgical removal is difficult and challenging, incomplete disease, facial disfigurement and recurrence. Objecve: to report the clinical case of a paentwith lingual hemangioma treatedwith 0.5% Polidocanol. iook 4 sessions of applicaon of thesclerosingagent to completelyretrachelesionwhere 1 ml wasused in eachinfiltraon and 0.7 ml in thelastsession, obtainingthedisappear of thelesion in thelaer, so the prognosis wasgood. Conclusion: According to the results of this study, the use of Polidocanol at 0.5% in lingual hemangioma treatmentsis a very effecve technique, and with its pracce we have a decrease in the volume of this lesion
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Soluciones Esclerosantes/uso terapéutico , Neoplasias de la Lengua/tratamiento farmacológico , Polidocanol/uso terapéutico , Hemangioma/tratamiento farmacológico , Soluciones Esclerosantes/administración & dosificación , Polidocanol/administración & dosificaciónRESUMEN
A insuficiência venosa crônica (IVC) não só representa um prejuízo na qualidade de vida (QV), como também gera um ônus aos recursos de saúde pública. A escleroterapia ecoguiada com espuma (EEE) vem se mostrando uma boa opção, porém, seu real impacto na QV ainda é incerto. Apresentamos aqui os resultados dos primeiros 27 casos de um estudo prospectivo longitudinal não controlado para avaliação da clínica e QV submetidos a EEE em portadores de IVC CEAP C4 a C6 com contraindicação de cirurgia convencional, com avaliação seriada da clínica por meio do Venous Clinical Severity Score (VCSS) e da QV com o questionário Assessment of Burden Chronic Disease - Venous (ABC-V). Observamos redução do VCSS de 22,2% (p < 0,001) na primeira semana e do score ABC-V de 37,8% (p = 0,003) no primeiro trimestre
Chronic Venous Insufficiency (CVI) is not only detrimental to patients' Quality of Life (QoL) but also places a considerable burden on public health resources. Ultrasound guided foam sclerotherapy (USFS) is a good treatment option, but its effect on patients' QOL is still unclear. This article presents the results from the first 27 patients in a prospective, longitudinal, non-controlled study for evaluation of the clinical and QOL impact of USFS treatment for CEAP C4 to C6 grade CVI with contraindications for open surgery. Clinical symptoms were measured with the Venous Clinical Severity Score (VCSS) and QOL by the Assessment of Burden Chronic Disease - Venous questionnaire (ABC-V). We observed 22.2% reductions in VCSS (p<0.001) in the first week after the procedure, and a 37.8% reduction in ABC-V scores (p=0.03) over the first 3 months
Asunto(s)
Calidad de Vida , Insuficiencia Venosa/terapia , Escleroterapia/efectos adversos , Escleroterapia/métodos , Extremidad Inferior , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Polidocanol/uso terapéuticoRESUMEN
Background Sclerotherapy has been gaining increased acceptance and popularity as an effective therapy for the treatment of varicose veins. This attention has fed growing interest into the safety and potential complications of this procedure. There is no evidence of pulmonary complications from foam sclerotherapy in humans; however, animal studies have shown possible damage. The aim of this study is to show the changes in rat pulmonary parenchyma after the injection of 1% polidocanol Tessari foam into the peripheral vein using histological analysis of the inflammatory and fibrosis processes. Methods Twenty-four Wistar rats were divided into the following four groups: 24 h polidocanol, seven-day polidocanol, 28-day polidocanol, and control group. After the foam was injected into the lateral saphenous vein, the lungs of the rats were removed for histological analysis. Results Alveolar edema was observed in only the 24 h group (P < 0.005). Vessel thickening was observed in the seven-and 28-day groups (P < 0.001). Interstitial fibrosis was found in only the 28-day group (P = 0.006). There was no evidence of venous or arterial thrombosis in either group. Conclusion Polidocanol Tessari foam injection into rat peripheral veins causes alveolar edema, vessel thickening, and interstitial fibrosis.
Asunto(s)
Enfermedades Pulmonares/inducido químicamente , Pulmón/efectos de los fármacos , Polietilenglicoles/administración & dosificación , Soluciones Esclerosantes/administración & dosificación , Escleroterapia , Várices/terapia , Venas/efectos de los fármacos , Animales , Fibrosis , Humanos , Inflamación , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Masculino , Polidocanol , Alveolos Pulmonares/metabolismo , Ratas , Ratas Wistar , Vena Safena/diagnóstico por imagen , Resultado del Tratamiento , Venas/diagnóstico por imagen , Insuficiencia Venosa/terapiaRESUMEN
Importance: Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant. Objective: To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2). Design, Setting, and Participants: Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs. Interventions: The patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins. Main Outcomes and Measures: The primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas). Results: Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P < .001). No serious adverse events occurred in either group. Pigmentation was the most common minor adverse event, with a 3.53% treated-vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09). Conclusions and Relevance: Sclerotherapy with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone in sclerosing reticular veins, with no statistical difference for complications. Pigmentation occurred in both groups, with no statistical difference between them. No serious adverse events occurred in either group. Trial Registration: clinicaltrials.gov Identifier: NCT02054325.
Asunto(s)
Solución Hipertónica de Glucosa/administración & dosificación , Polietilenglicoles/administración & dosificación , Soluciones Esclerosantes/administración & dosificación , Escleroterapia/métodos , Enfermedades Vasculares/terapia , Adolescente , Adulto , Anciano , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Extremidad Inferior , Persona de Mediana Edad , Polidocanol , Estudios Prospectivos , Escleroterapia/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Vasculares/patología , Venas/patología , Adulto JovenRESUMEN
The endovenous laser ablation (EVLA) of the insufficient saphenous vein has similar results to open conventional surgery, but less morbidity. The echo-guided polidocanol foam sclerotherapy technique has been used for the same purpose. The combined techniques may play a role for more severe diseases, such as those with varicose ulcers. An EVLA device (called VELAS) has been developed in the Optics and Photonics Research Center of USP-São Carlos in agreement with FMB-UNESP. In this study, we present the preliminary results of the VELAS device (MMO 980nm diode) in patients with chronic venous ulcer, associated with echo-guided polidocanol foam sclerotherapy for the treatment of varicosities. Primary outcomes were healing time of the venous ulcer, occlusion of the treated veins and treatment-related adverse events. We included 12 patients with insufficient saphenous vein and chronic venous ulcer. Initially, we treated all of them with thermoablation of the insufficient saphenous vein (VELAS), on an outpatient basis, with local anesthesia. After one week of the procedure, we sclerosed the varicosities with polidocanol foam (Tessari technique). The national VELAS device was easily handled. Total venous occlusion occurred in 83.3% of the patients (in seven days) and the association of the techniques was responsible for a wound healing rate of 83.3%, with no adverse events.
Asunto(s)
Procedimientos Endovasculares/métodos , Terapia por Láser , Láseres de Semiconductores/uso terapéutico , Polietilenglicoles/uso terapéutico , Vena Safena , Soluciones Esclerosantes/uso terapéutico , Escleroterapia , Insuficiencia Venosa/terapia , Adulto , Anciano , Brasil , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polidocanol , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
RESUMO A termoablação endovascular das veias safenas insuficientes com laser é descrita como uma técnica menos invasiva, com resultados semelhantes à cirurgia convencional, porém, com efeitos adversos menos frequentes. A técnica de escleroterapia com espuma de polidocanol ecoguiada vem sendo empregada com a mesma finalidade. A combinação de técnicas pode representar uma alternativa para pacientes mais graves, como os portadores de úlcera varicosa. Um equipamento de laser (denominado VELAS) foi desenvolvido no Centro de Pesquisas em Ótica e Fotônica da USP-São Carlos em convênio com a FMB-UNESP para termoablação endoluminal da veia safena insuficiente. Neste estudo apresentamos os resultados preliminares do uso do aparelho de laser VELAS (diodo MMO 980nm) na termoablação endovascular de veias safenas insuficientes, em portadores de úlcera venosa crônica, associado à complementação com espuma de polidocanol para o tratamento de varicosidades, após uma semana. Os desfechos analisados foram o tempo de cicatrização da úlcera venosa, oclusão das veias tratadas e eventos adversos relacionados aos tratamentos. Foram incluídos 12 pacientes portadores de insuficiência de veia safena e úlcera venosa crônica que aceitaram participar do projeto. Todos foram tratados em regime ambulatorial, com anestesia local e termoablação da veia safena insuficiente (VELAS). Após uma semana da cirurgia, as varicosidades foram esclerosadas com polidocanol espuma (técnica de Tessari). O equipamento laser VELAS nacional apresentou fácil manuseio, oclusão venosa total em 83,3% dos pacientes (em sete dias) e a associação das técnicas foi responsável por uma taxa de cicatrização de feridas de 83,3%, sem ocorrência de eventos adversos.
ABSTRACT The endovenous laser ablation (EVLA) of the insufficient saphenous vein has similar results to open conventional surgery, but less morbidity. The echo-guided polidocanol foam sclerotherapy technique has been used for the same purpose. The combined techniques may play a role for more severe diseases, such as those with varicose ulcers. An EVLA device (called VELAS) has been developed in the Optics and Photonics Research Center of USP-São Carlos in agreement with FMB-UNESP. In this study, we present the preliminary results of the VELAS device (MMO 980nm diode) in patients with chronic venous ulcer, associated with echo-guided polidocanol foam sclerotherapy for the treatment of varicosities. Primary outcomes were healing time of the venous ulcer, occlusion of the treated veins and treatment-related adverse events. We included 12 patients with insufficient saphenous vein and chronic venous ulcer. Initially, we treated all of them with thermoablation of the insufficient saphenous vein (VELAS), on an outpatient basis, with local anesthesia. After one week of the procedure, we sclerosed the varicosities with polidocanol foam (Tessari technique). The national VELAS device was easily handled. Total venous occlusion occurred in 83.3% of the patients (in seven days) and the association of the techniques was responsible for a wound healing rate of 83.3%, with no adverse events.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Polietilenglicoles/uso terapéutico , Vena Safena , Soluciones Esclerosantes/uso terapéutico , Insuficiencia Venosa/terapia , Escleroterapia , Terapia por Láser , Láseres de Semiconductores/uso terapéutico , Procedimientos Endovasculares/métodos , Índice de Severidad de la Enfermedad , Brasil , Resultado del Tratamiento , Terapia Combinada , Polidocanol , Persona de Mediana EdadRESUMEN
OBJECTIVE: Placenta accreta is one of the main obstetrical complications worldwide. The aim of this study was to report the experience of managing placenta accreta with a 6% polidocanol solution sclerotherapy. MATERIALS AND METHODS: We selected patients between 37 weeks of gestation and 38 weeks of gestation, diagnosed with placenta accreta, treated at the Maternal Perinatal Hospital "Monica Pretelini Sáenz", Toluca, Mexico, during the period from November 2013 to August 2014. The surgical technique has two steps: (1) fundic-arciform caesarean section followed by a 6% polidocanol sclerosing solution through a 6Fr neonatal feeding tube upon its reaching the placental bed; (2) total abdominal hysterectomy with internal hypogastric artery ligation. RESULTS: Data were collected from 11 patients with a mean age of 33.9 years (range, 26-42 years) and 2.8±0.6 days of hospitalization in the obstetrical intensive care unit. The majority of patients were classified as having pregnancies at an advanced age. All women were multigravidas. Bleeding volume exhibited a range between 2.5 L and 3 L without any case of neonatal death but one mother died because of coagulopathy. CONCLUSION: We conclude that the technique that we are reporting is feasible for implementation in obstetric hospitals, with technical and economic feasibility.
Asunto(s)
Placenta Accreta/terapia , Polietilenglicoles/administración & dosificación , Escleroterapia/métodos , Adulto , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Polidocanol , Embarazo , Resultado del Embarazo , Estudios Prospectivos , Soluciones Esclerosantes/administración & dosificaciónRESUMEN
BACKGROUND: Telangiectasias are defined as small venules abnormally dilated, located in the intradermal portion of the skin, of reddish or bluish tinge, their diameter not exceeding 1âmm; they are classified by the American Venous Forum as mild venous disease CEAP C1. Conventional treatment consists of chemical sclerotherapy, considered a minimally invasive technique with rapid clinical recovery. A wide variety of sclerosing solutions can be used for this purpose. METHODS/DESIGN: This project intends to include 96 patients that will be randomized to a triple-blind study. Inclusion criteria are women between 18 and 65 years, with telangiectasia on the lateral thigh. Male patients, female patients with chronic venous disease CEAP 2 to 6, women with allergies, pregnant, breastfeeding, with any type of skin problems or any decompensated clinical disease will be excluded. All patients included will be submitted to venous ultrasound mapping in order to rule out venous disease not clinically visible, deep venous system insufficiency, and insufficiency of the ostial valve of the great saphenous vein. One group will be treated with glucose 75% solution and the other will receive polidocanol 0.2% diluted in glucose 70%. Each patient will receive only 1 treatment session in 1 single member. The volume of sclerosing solution will not exceed 5âmL and the treatment area will be limited to a region of 150âcm on the lateral thigh. Clinical follow-up will be: 1 initial visit, when the clinical report will be filled; photographic record and treatment with sclerotherapy (D0); follow-up visits after 7 and 60 days (D7 and D60, respectively), always with clinical and photographic documentation. DISCUSSION: The project intends to evaluate the efficacy and safety of sclerotherapy in eliminating telangiectasia in a predetermined area in order to establish efficacy and safety parameters for the treatments presented. CONCLUSION: This protocol for clinical trial will provide date to determine the efficacy and safety of sclerotherapy with the solutions presented. TRIAL REGISTRATION IDENTIFIER: ClinicalTrial.gov NCT02657252 Date: 01/12/2016 (retrospectively registered).
Asunto(s)
Glucosa/uso terapéutico , Polietilenglicoles/uso terapéutico , Soluciones Esclerosantes/uso terapéutico , Escleroterapia/métodos , Telangiectasia/terapia , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polidocanol , Proyectos de Investigación , Muslo , Adulto JovenRESUMEN
BACKGROUND: To compare polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and active ulcer treated at a single vascular center. METHODS: Fifty-eight limbs of 56 patients with active ulcers were prospectively randomized to undergo either surgical treatment or foam sclerotherapy. Patients completed the Aberdeen Varicose Veins Questionnaire (AVVQ), the Venous Clinical Severity Score (VCSS), and Venous Disability Score (VDS). The follow-up was 502 ± 220 days. RESULTS: The ulcer healed in 100% and 91.3% of patients treated with surgery or foam sclerotherapy, respectively (P > 0.05). There were no significant differences in AVVQ, VCSS, and VDS between the 2 groups after the procedures (P = 0.45, 0.58, and 0.66, respectively; Mann-Whitney U test). Complications occurred in 14.2% and 13.0% in the surgical and foam sclerotherapy groups, respectively. CONCLUSIONS: Surgical treatment and foam sclerotherapy achieved high rates of ulcer healing, without a statistically significant difference. Both treatments led to significant improvements in VCSS, VDS, AVVQ scores, demonstrating improvements in clinical outcomes and quality of life.
Asunto(s)
Polietilenglicoles/administración & dosificación , Soluciones Esclerosantes/administración & dosificación , Escleroterapia/métodos , Úlcera Varicosa/terapia , Procedimientos Quirúrgicos Vasculares , Insuficiencia Venosa/terapia , Adulto , Brasil , Enfermedad Crónica , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polidocanol , Polietilenglicoles/efectos adversos , Estudios Prospectivos , Calidad de Vida , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Insuficiencia Venosa/diagnóstico , Insuficiencia Venosa/cirugía , Cicatrización de HeridasRESUMEN
BACKGROUND: The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally invasive alternatives, promoting chemical sclerosis of the vein wall. Although this technique is routinely performed around the world, there is no consensus on the most efficacious and safe chemical agent to be used. METHODS/DESIGN: Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs, on the outer side of the leg/thigh. Patients with CEAP 2 to 6, or with allergies, pregnancy, performing breastfeeding, or with any dermatologic or clinical problems will be excluded. Patients with venous ultrasound mapping showing involvement of saphenous trunks and/or a deep venous system will also be excluded. Patients will be randomized into two groups, one receiving 75% pure glucose and the other group receiving 0.2% polidocanol diluted in 70% glucose. Just one limb and one session per patient will be performed. The sclerosing agent volume will not exceed 5 mL. Clinical follow-up will include visits on days 7 and 60, always with photographic documentation. DISCUSSION: This project aims to enroll 96 patients and subject them to a double-blind treatment after the randomization process. The design is intended to evaluate efficacy through a primary end point and safety through a secondary end point. Forty-eight patients have currently been enrolled. Preliminary results for these patients showed that 25 received treatment, 2 were excluded, and 22 returned after 7 days and showed no greater adverse events. To date, establishing efficacy criteria has not been possible, and no patients have reached the 60-day return point. These data may help doctors choose the best chemical agent for the treatment of reticular veins. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02054325, 3/02/2014.
Asunto(s)
Solución Hipertónica de Glucosa/administración & dosificación , Extremidad Inferior/irrigación sanguínea , Polietilenglicoles/administración & dosificación , Proyectos de Investigación , Soluciones Esclerosantes/administración & dosificación , Escleroterapia/métodos , Telangiectasia/terapia , Várices/terapia , Adolescente , Adulto , Anciano , Brasil , Enfermedad Crónica , Protocolos Clínicos , Método Doble Ciego , Femenino , Solución Hipertónica de Glucosa/efectos adversos , Humanos , Persona de Mediana Edad , Polidocanol , Polietilenglicoles/efectos adversos , Estudios Prospectivos , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Telangiectasia/diagnóstico , Factores de Tiempo , Resultado del Tratamiento , Várices/diagnóstico , Adulto JovenRESUMEN
OBJECTIVE: Refluxing perforators contribute to venous ulceration. We sought to describe patient characteristics and procedural factors that (1) impact rates of incompetent perforator vein (IPV) thrombosis with ultrasound-guided sclerotherapy (UGS) and (2) impact the healing of venous ulcers (CEAP 6) without axial reflux. METHODS: A retrospective review of UGS of IPV injections from January 2010 to November 2012 identified 73 treated venous ulcers in 62 patients. Patients had no other superficial or axial reflux and were treated with standard wound care and compression. Ultrasound imaging was used to screen for refluxing perforators near ulcer(s). These were injected with sodium tetradecyl sulfate or polidocanol foam and assessed for thrombosis at 2 weeks. Demographic data, comorbidities, treatment details, and outcomes were analyzed. Univariate and multivariable modeling was performed to determine covariates predicting IPV thrombosis and ulcer healing. RESULTS: There were 62 patients (55% male; average age, 57.1 years) with active ulcers for an average of 28 months with compression therapy before perforator treatment, and 36% had a history of deep venous thrombosis and 30% had deep venous reflux. At a mean follow-up of 30.2 months, ulcers healed in 32 patients (52%) and did not heal in 30 patients (48%). Ulcers were treated with 189 injections, with an average thrombosis rate of 54%. Of 73 ulcers, 43 ulcers (59%) healed, and 30 (41%) did not heal. The IPV thrombosis rate was 69% in patients whose ulcers healed vs 38% in patients whose ulcers did not heal (P < .001). Multivariate models demonstrated male gender (P = .03) and warfarin use (P = .01) negatively predicted thrombosis of IPVs. A multivariate model for ulcer healing found complete IPV thrombosis was a positive predictor (P = .02), whereas a large initial ulcer area was a negative predictor (P = .08). Increased age was associated with fewer ulcer recurrences (P = .05). Predictors of increased ulcer recurrences were hypertension (P = .04) and increased follow-up time (P = .02). Calf vein thrombosis occurred after 3% (six of 189) of injections. CONCLUSIONS: Thrombosis of IPVs with UGS increases venous ulcer healing in a difficult patient population. Complete closure of all IPVs in an ulcerated limb was the only predictor of ulcer healing. Men and patients taking warfarin have decreased rates of IPV thrombosis with UGS.