Serum Ethanol Levels in Children and Adults after Ethanol Embolization or Sclerotherapy for Vascular Anomalies

Abstract

The volume of ethanol administered is the most reliable predictor of serum ethanol level and legal intoxication. Patients who receive up to 1.0 mL/kg ethanol during embolization or sclerotherapeutic procedures may have elevated serum ethanol levels that could put them at risk of respiratory depression, cardiac arrhythmias, seizures, rhabdomyolysis, and hypoglycemia.

Ethanol Embolization of Arteriovenous Malformations of the Mandible

“…The total maximal dose that can be given in an embolization procedure in 1 day to a patient is 1 mL/kg body weight. 13 Technical intraprocedural requirements for the use of ethanol include superselective catheter placement or direct deposition of ethanol within the nidus of the vascular lesion so as to avoid injection of ethanol into healthy vessels and tissues, use of general anesthesia with appropriate intraprocedural monitoring, good immediate postoperative care including appropriate use of medication to reduce any postoperative adverse effects, and careful clinical follow-up with appropriate re-do therapy when necessary to produce maximal benefit for the patients. Fiber coils were preferred in our experience because of the safety and more efficient induction of clotting, but there are also some disadvantages, such as difficulty in filling the nidus completely and inability to destroy the endothelial cells of the lesion.…”

Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches

“…40,43 In addition, systemic side effects can occur when concentrated ethanol makes its way into the systemic circulation. Compartment syndrome, 44 arrhythmia, 45 pulmonary embolism, 46 pulmonary hypertension with right heart failure 47 and haemoglobinuria 48 after ethanol sclerotherapy have all been reported in the literature.…”

Ethanol Embolization of Auricular Arteriovenous Malformations: Preliminary Results of 17 Cases

“…4,20,22 In most institutions, the maximal volume of ethanol used in treating patients with AVMs is 1.0 mL/kg body weight on the basis of clinical experience. 4,5,20,21,23,26 However, the safety of this dose has not been confirmed. It was reported that idiosyncratic reactions may occur with the use of as little as 1.0 mL of ethanol.…”

“…4,18,19 Injecting ethanol into the nidus of the AVMs denatures blood proteins, dehydrates vascular endothelial cells and precipitates their cytoplasm, denudes the vascular wall totally of endothelial cells, and segmentally fractures the vascular wall to the level of the internal elastic lamina. 5,[19][20][21][22] In addition, acute thrombus formation is promoted by vascular spasm and perivascular necrosis. 23 Compared with other embolic agents, ethanol has many attractive properties for use in AVM management.…”