Ethanol sclerotherapy of rectal venous abnormalities in Klippel-Trenaunay syndrome

Agostinho, Nelson; Ge, Ludi; Solomon, Michael J.

doi:10.1093/jscr/rju080

Cited by 5 publications

(3 citation statements)

References 9 publications

(11 reference statements)

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“…Sclerotherapy is performed frequently and effectively in the treatment of VMs 19 . Endoscopy-guided hybrid sclerotherapy of colonic VMs may be a viable therapeutic option 5 , but research supporting this treatment is rare and until now has only been described in case reports 20,21 . One study 20 presented two patients who suffered from massive venous malformations.…”

Section: Discussionmentioning

confidence: 99%

Rectosigmoidal manifestations of venous malformations: MR imaging findings and interdisciplinary therapeutic modalities

Brill

Brill²,

Uller

et al. 2019

Sci Rep

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The aim of this study was to identify the frequency of rectosigmoidal involvement in patients with venous malformations (VM) of the lower extremities and to demonstrate multidisciplinary therapeutic options. The medical records and magnetic resonance images (MRI) of patients with VM of the lower extremities, over a six-year period, were reviewed retrospectively in order to determine the occurrence of rectosigmoidal involvement. Vascular interventions, surgical treatments, percutaneous and hybrid (endoscopy-guided angiography) sclerotherapy and procedural complications (according to Clavien-Dindo classification) were also noted. Of the 378 patients with vascular malformation of the lower limbs, 19 patients (5%) had documented venous rectosigmoidal malformation. All of these 19 patients reported episodes of rectal bleeding, while seven patients (36.8%) also had anemia. All patients underwent endoscopy. By endoscopy, seven patients (36.8%) showed discreet changes, and 12 patients (63.2%) showed pronounced signs of submucosal VM with active (47.3%) or previous (15.7%) bleeding. Treatment was performed in all patients with pronounced findings. Six patients underwent endoscopy-guided hybrid sclerotherapy, one patient underwent endoscopic tissue removal, one patient received percutaneous sclerotherapy and one patient received a combination of transvenous embolization and hybrid sclerotherapy. Three patients required open surgery. No complications occurred after conservative treatments; however, one complication was reported after open surgery. None of the treated patients reported further bleeding and anemia at the end of the follow-up period. In this cohort, rectosigmoidal VM occurred in 5% of patients presenting with a high incidence of rectal bleeding. Percutaneous or endoscopy-guided hybrid sclerotherapy appeared to be a safe and effective alternative to surgery.

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Section: Discussionmentioning

confidence: 99%

Rectosigmoidal manifestations of venous malformations: MR imaging findings and interdisciplinary therapeutic modalities

Brill

Brill²,

Uller

et al. 2019

Sci Rep

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show abstract

“… 6 Embolization of lesions has been performed using a variety of agents, including ethanol. Agostinho et al 12 reported a case of a patient with Klippel-Trenaunay syndrome who had presented with hematochezia resulting in anemia secondary to multiple giant rectal VMs. They reported resolution of hematochezia and a decrease in the size of the large rectal VMs after injection of 75% ethanol.…”

Section: Discussionmentioning

confidence: 99%

“…They reported resolution of hematochezia and a decrease in the size of the large rectal VMs after injection of 75% ethanol. 12 However, they acknowledged a set of major adverse events related to distal embolization, including pulmonary embolism and cardiovascular collapse. 12 We continue to advise against the use of ethanol for the treatment of more voluminous VMs owing to the high rates of serious complications, despite its highly effective therapeutic profile.…”

Section: Discussionmentioning

confidence: 99%