Percutaneous drainage and sclerotherapy as definitive treatment of

Valério, Massimo; Meuwly, Jean‐Yves; Tawadros, Cécile; Jichlinski, Patrice

doi:10.5489/cuaj.334

Cited by 14 publications

(6 citation statements)

References 15 publications

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“…In case of haemorrhagic complications, the cystic cavity content may become heterogenous with the typical density and signal of blood at CT and MR, respectively 4 7. Interventional radiology offers minimal invasive treatment (percutaneous drainage with sclerotherapy) in order to avoid the need for marsupialisation, which is associated with a risk of haemorrhage and may result in nephrectomy 8 9…”

Section: Discussionmentioning

confidence: 99%

Renal peripelvic lymphangiectasia after bilateral renal vein thrombosis

Villard¹,

Meuwly²,

Righini³

et al. 2022

BMJ Case Rep

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Renal peripelvic lymphangiectasia (RPL) is one of the rare conditions that mimic renal cysts. Its physiopathology remains unknown, but an association with renal vein thrombosis has been reported. We share the case of a male patient in his 20s suffering from antiphosphlipid syndrome. The patient was hospitalised for thrombosis of the inferior vena cava (IVC) extending from the iliac veins to the level of renal veins. Consecutive CT and clinical follow-up over the course of 14 years showed the development of numerous retroperitoneal venous collaterals and the apparition of several bilateral peripelvic cystic lesions after extensive thrombosis of the IVC and both renal veins. The renal function remained normal throughout the follow-up. We suggest that the development of RPL is secondary to bilateral renal vein thrombosis. The presumed mechanism would be an increased hydrostatic pressure in the kidney capillaries leading to a more important interstitial fluid drainage by the lymphatic system. To our knowledge, this is the first well-documented case of renal vein thrombosis followed by RPL, contrasting with the previous hypothesis that compression by the lymphangiectasia could cause the thrombosis.

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Section: Discussionmentioning

confidence: 99%

Renal peripelvic lymphangiectasia after bilateral renal vein thrombosis

Villard¹,

Meuwly²,

Righini³

et al. 2022

BMJ Case Rep

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“…There are no published reports regarding the safety of sclerotherapy for lower extremity veins in patients with renal failure or hepatic impairment. However, successful use of sclerotherapy with 3% STS 206,207 has been reported for treating renal cysts in polycystic kidney disease, 208 and detergent sclerosants are commonly used to treat bleeding oesophageal varices complicating chronic liver disease. 209,210 STS is mostly excreted in urine and POL is equally excreted in urine and faeces.…”

Section: Consensus 25mentioning

confidence: 99%

Sclerotherapy of lower limb veins: Indications, contraindications and treatment strategies to prevent complications – A consensus document of the International Union of Phlebology-2023

Wong

Parsi

Myers³

et al. 2023

Phlebology

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Background Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events. Objectives To categorise contraindications to sclerotherapy based on the available scientific evidence. Methods An international, multi-disciplinary panel of phlebologists reviewed the available scientific evidence and developed consensus where evidence was lacking or limited. Results Absolute Contraindications to sclerotherapy where the risk of harm would outweigh any benefits include known hypersensitivity to sclerosing agents; acute venous thromboembolism (VTE); severe neurological or cardiac adverse events complicating a previous sclerotherapy treatment; severe acute systemic illness or infection; and critical limb ischaemia. Relative Contraindications to sclerotherapy where the potential benefits of the proposed treatment would outweigh the risk of harm or the risks may be mitigated by other measures include pregnancy, postpartum and breastfeeding; hypercoagulable states with risk of VTE; risk of neurological adverse events; risk of cardiac adverse events and poorly controlled chronic systemic illness. Conditions and circumstances where Warnings and Precautions should be considered before proceeding with sclerotherapy include risk of cutaneous necrosis or cosmetic complications such as pigmentation and telangiectatic matting; intake of medications such as the oral contraceptive and other exogenous oestrogens, disulfiram and minocycline; and psychosocial factors and psychiatric comorbidities that may increase the risk of adverse events or compromise optimal treatment outcomes. Conclusions Sclerotherapy can achieve safe clinical outcomes provided that (1) patient-related risk factors and in particular all material risks are (1a) adequately identified and the risk benefit ratio is clearly and openly discussed with treatment candidates within a reasonable timeframe prior to the actual procedure; (1b) when an individual is not a suitable candidate for the proposed intervention, conservative treatment options including the option of ‘ no intervention as a treatment option’ are discussed; (1c) complex cases are referred for treatment in controlled and standardised settings and by practitioners with more expertise in the field; (1d) only suitable individuals with no absolute contraindications or those with relative contraindications where the benefits outweigh the risks are offered intervention; (1e) if proceeding with intervention, appropriate prophylactic measures and other risk-mitigating strategies are adopted and appropriate follow-up is organised; and (2) procedure-related risk factors are minimised by ensuring the treating physicians (2a) have adequate training in general phlebology with additional training in duplex ultrasound, procedural phlebology and in particular sclerotherapy; (2b) maintain their knowledge and competency over time and (2c) review and optimise their treatment strategies and techniques on a regular basis to keep up with the ongoing progress in medical technology and contemporary scientific evidence.

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“…Percutaneous drainage, despite being easy to perform, is often only a temporary measure and cannot be considered a definitive solution because it is inevitably followed by recurrence and might also be difficult to achieve complete drainage in the presence of septations [2,3,9,14]. Definitive surgical interventions reported in the literature include marsupialisation, sclerotherapy and nephrectomy (Table 1) [2,3,9,15,16]. Marsupialisation has been reported to be complicated by extensive hemorrhage mandating nephrectomy [14,16].…”

Section: Lymphoma VI Nephroblastomatosismentioning

confidence: 99%

“…Sclerotherapy in conjunction with percutaneous drainage can conversely avoid such complications. Povidone-iodine can be used as a sclerosant as it is homogeneously distributed, long-acting and minimally irritative to the urinary tract, which prevents stricture formation [3,15]. Nephrectomy is not commonly performed and is reserved for recurrent collections or uncontrolled intraoperative bleeding [4,17].…”

Section: Lymphoma VI Nephroblastomatosismentioning

confidence: 99%

Renal Lymphangiectasia as an Unusual Cause of Perirenal Collections: A Case Report and Literature Review

Xanicia¹,

Kit²

2021

JSCR

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Renal lymphangiectasia (RLM) is a rare condition characterized by dilatation of perirenal, parapelvic or intrarenal lymphatics. We report an unusual case of bilateral RLM in a 20-year-old Malay male who presented with 1 month duration of bilateral flank pain. Bedside ultrasound showed bilateral perinephric collections, which were further confirmed on computer tomography intravenous pyelogram (CT IVP). Other causes of perinephric collections were ruled out based on laboratory and radiological findings, and he was managed conservatively as for RLM with surveillance ultrasound kidneys at 3 to 6 monthly intervals.

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Percutaneous drainage and sclerotherapy as definitive treatment of

Cited by 14 publications

References 15 publications

Renal peripelvic lymphangiectasia after bilateral renal vein thrombosis

Renal peripelvic lymphangiectasia after bilateral renal vein thrombosis

Sclerotherapy of lower limb veins: Indications, contraindications and treatment strategies to prevent complications – A consensus document of the International Union of Phlebology-2023

Renal Lymphangiectasia as an Unusual Cause of Perirenal Collections: A Case Report and Literature Review

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