Intramuscular low flow vascular malformations: treatment by means of direct percutaneous embolization

Gorriz, E.; Carreira, José M.; Reyes, R; Gervás, C.; Pulido, Juan Manuel Pericás; Pardo, María Dolores; Maynar, Manuel

doi:10.1016/s0720-048x(97)00045-4

Cited by 22 publications

(10 citation statements)

References 6 publications

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“…However, with reduced dosing first established in LMs (e.g., less than 1 mg/kg per session, more than 2 weeks between sessions, and no more than 5 mg/kg lifetime), this complication has not yet been reproducibly identified. [83][84][85][86][87] Other currently used or historically significant sclerosant agents in the treatment of VMs include ethanolamine oleate, 65,[88][89][90] sodium morrhuate, 56 and alcoholic solution of zein (Ethibloc, Ethicon, Norderstedt, Germany), 50,[91][92][93] to name a few.…”

Section: Technique Of Sclerotherapy For Venous Malformationsmentioning

confidence: 99%

A Step-by-Step Practical Approach to Imaging Diagnosis and Interventional Radiologic Therapy in Vascular Malformations

Legiehn

Heran

2010

Semin intervent Radiol

110

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Within vascular anomalies, vascular malformations are those present at birth that grow with the patient and exhibit abnormal dilated vascular channels lined by mature endothelium. Vascular tumors, the other group of vascular anomalies, demonstrate endothelial hypercellularity. Vascular malformations are further divided into low-flow varieties (capillary, venous, and lymphatic malformations) and high-flow varieties (arteriovenous malformation and fistula). All malformations exhibit a predictable group of clinical patterns that vary in severity and rate of progression. The interventional radiologist must incorporate this clinical data with characteristic ultrasound and magnetic resonance findings to arrive at a diagnosis. One must then decide in a multidisciplinary fashion, based on objective clinical criteria and image-based morphology, if the patent is a candidate for intervention. Sclerotherapy is a technique used to treat vascular malformations whereby an endothelial-cidal agent is introduced into the endoluminal compartment to initiate vascular closure. The high flow rate of an arteriovenous malformation requires the incorporation of superselective transarterial, direct, and transvenous access with flow reduction techniques to deliver adequate dose of sclerosant and embolic to the nidus. Satisfactory outcomes are seen in over half of all malformations patients. Similar treatment-related complications are seen between malformations but are lowest in lymphatic and highest in arteriovenous malformations.

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Section: Technique Of Sclerotherapy For Venous Malformationsmentioning

confidence: 99%

A Step-by-Step Practical Approach to Imaging Diagnosis and Interventional Radiologic Therapy in Vascular Malformations

Legiehn

Heran

2010

Semin intervent Radiol

110

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“…The therapeutic options for IMVM include conservative treatment with compressive garments or antithrombotic drugs, or both, sclerotherapy, embolisation, and excision [2,5,6]. In cases involving lesions in the distal extremities and those with severe compressive neuronal symptoms, excision may be recommended, though sclerotherapy is now preferred because it is more likely to be curative and is safer than conservative treatment or aggressive excision [3].…”

Section: Introductionmentioning

confidence: 99%

“…In cases involving lesions in the distal extremities and those with severe compressive neuronal symptoms, excision may be recommended, though sclerotherapy is now preferred because it is more likely to be curative and is safer than conservative treatment or aggressive excision [3]. Excision is not recommended for extensive IMVM because of the functional results of neural or muscular damage [2,5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and evaluation of safety of sclerosants for intramuscular venous malformations: Clinical and experimental studies

Ozaki¹,

Kurita²,

Kaji³

et al. 2010

Journal of Plastic Surgery and Hand Surgery

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Excision of intramuscular venous malformations may damage intact functional muscles, and sclerotherapy is an alternative way of relieving symptoms. Several sclerosants are available, but selection of the optimal one is controversial. We report our clinical experiences of sclerotherapy, and experimental studies in rats that investigated muscular damage after injection of various sclerosants. For the clinical study, 10 patients with intramuscular venous malformations were reviewed who had been treated by sclerotherapy using ethanolamine oleate. The rate by which the volume reduced was assessed quantitatively using findings from magnetic resonance imaging (MRI). Pain was cured or improved in all cases, and volume reduced on imaging analysis. There were no severe complications such as renal failure or thromboembolism. For the experimental study, 62 Wistar rats were used to investigate the toxicity of sclerosants on the intact-muscle by injecting three types of sclerosants (100% ethanol, 5% ethanolamine oleate, and 1% polidocanol). After the injection of each sclerosant into the anterior tibial muscle, the daily measurement of the circumference of the legs, histological and morphological alterations in the muscles, and maximal isometric tetanic tension, were investigated. Swelling was most prominent with ethanolamine oleate, while destruction and atrophy of the muscle were most prominent after injection of ethanol. In the clinical study, the efficacy of 5% ethanolamine oleate was at least equivalent or possibly superior to that of 100% ethanol. In the experimental study, ethanol had a more detrimental effect on muscles than the other agents. We consider that ethanolamine oleate is the most suitable sclerosant for the treatment of intramuscular venous malformations.

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“…It is also a good alternative for embolizing peripheral vascular malformations ( Figure 6A–C ). 69 Furthermore, absolute alcohol has been used for occlusion of varicose veins. It can also be an alternative in hemorrhagic conditions, if no other embolization material is available.…”

Section: Liquidsmentioning

confidence: 99%

Endoluminal occlusion devices: technology update

Zander¹,

Medina²,

Montes³

et al. 2014

MDER

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Endoluminal occlusion has been performed since the early beginning of interventional radiology. Over recent decades, major technological advances have improved the techniques used and different devices have been developed for changing conditions. Most of these occlusion devices have been implemented in the vascular territory. Early embolization materials included glass particles, hot contrast, paraffin, fibrin, and tissue fragments such as muscle fibers and blood clots; today, occlusion materials include metallic devices, particles, and liquid materials, which can be indicated for proximal or distal occlusion, high-flow and low-flow situations, and in large-caliber and small-caliber vessels, based on need. Technological progress has led to a decreased size of delivery catheters, and an increase in safety due to release systems that permit the withdrawing and replacement of embolization material. Furthermore, bioactive embolization materials have been developed to increase the efficacy of embolization or the biological effect of medication. Finally, materials have been modified for changing indications. Intravascular stents were initially developed to keep an artery open; however, by adding a covering membrane, these stents can be used to occlude the wall of a vessel or other endoluminal structures. This article gives an overview of the devices most utilized for occlusion of endoluminal structures, as well as their major purpose in the endovascular territory.

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Intramuscular low flow vascular malformations: treatment by means of direct percutaneous embolization

Cited by 22 publications

References 6 publications

A Step-by-Step Practical Approach to Imaging Diagnosis and Interventional Radiologic Therapy in Vascular Malformations

A Step-by-Step Practical Approach to Imaging Diagnosis and Interventional Radiologic Therapy in Vascular Malformations

Efficacy and evaluation of safety of sclerosants for intramuscular venous malformations: Clinical and experimental studies

Endoluminal occlusion devices: technology update

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