Polidocanol-foam treatment of varicose veins: Quality-of-life impact compared to conventional surgery

Abstract 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.

Evaluation of the efficacy and safety of endoscopic injection of polidocanol combined with low-dose tissue glue occlusion in the treatment of F3 type esophageal varices in liver cirrhosis / 中国医师杂志

Objective:To explore the efficacy and safety of endoscopic injection of polidocanol combined with low-dose tissue glue occlusion in the treatment of F3 esophageal varices in liver cirrhosis.Methods:Retrospective analysis was made on 42 patients with cirrhosis type F3 esophageal varices admitted to the Affiliated Hospital of Zunyi Medical University from January 2020 to June 2021. According to different treatment methods, they were divided into the observation group and the control group, with 21 cases in each group. The observation group received endoscopic injection of polidocanol combined with low-dose tissue glue occlusion, while the control group received endoscopic injection of polidocanol. The differences in the effectiveness (remission rate of varices) and safety (incidence of intraoperative bleeding and postoperative rebleeding, incidence of ectopic embolism, incidence of esophageal ulcer, incidence of esophageal perforation, incidence of esophageal stricture) of the two groups of patients were compared.Results:The total effective rate of relieving esophageal varices in the observation group was significantly better than that in the control group [95.2%(20/21) vs 61.9%(13/21), χ 2=6.929, P=0.008]. There were no cases of ectopic embolism in both groups; The intraoperative bleeding rate in the observation group was 4.8% (1/21), significantly lower than the 38.1% (8/21) in the control group (χ 2=6.929, P=0.008); There was no statistically significant difference in postoperative rebleeding rates between the two groups [33.3%(7/21) vs 23.8%(5/21), χ 2=0.467, P=0.495]; The incidence of esophageal ulcers in the observation group was higher than that in the control group [23.8%(5/21) vs 0, χ 2=5.676, P=0.017], mainly caused by glue discharge ulcers; There were no cases of esophageal perforation and esophageal stricture in both groups. Conclusions:Endoscopic injection of polidocanol combined with low-dose tissue glue occlusion for the treatment of F3 esophageal varices in liver cirrhosis is safe, can greatly reduce the occurrence of intraoperative bleeding, and has a better one-time variceal eradication effect.

Comparison of endoscopic sclerotherapy with polycinnamol solution and foam injection in the treatment of grade II hemorrhagic internal hemorrhoids / 中国医师杂志

Objective:To compare the efficacy and safety of endoscopic sclerotherapy with polycinnamol solution and foam in the treatment of grade II hemorrhagic internal hemorrhoids.Methods:From September 2020 to June 2021, 81 patients with grade II hemorrhagic internal hemorrhoids were collected from the Department of Gastroenterology, the First Affiliated Hospital of University of Science and Technology of China. They were randomly divided into an observation group and a control group. The observation group was injected with polycinnamol solution, and the control group was injected with polycinnamol foam. All of them were treated with endoscopic sclerotherapy. The clinical data of the two groups were compared and analyzed. The operation time, immediate hemostasis rate, incidence of postoperative complications (such as fever, pain, bleeding and Urinary retention), recurrence and rebleeding rate of the two groups were observed, and the efficacy and safety of the two groups in the treatment of grade II hemorrhagic internal hemorrhoids were compared.Results:There was no statistically significant difference in basic data between the two groups of patients (all P>0.05), indicating comparability. The surgical operation time of the observation group patients [(7.40±1.18)min] was shorter than that of the control group [(13.88±0.95)min] ( P<0.05); The injection dose of polycinnamol [(5.79±1.61)ml] in the observation group was higher than that in the control group [(4.38±1.92)ml] ( P<0.05). The immediate postoperative hemostasis rate in the observation group was the same as that in the control group (100%). The incidence of postoperative fever (7.32%), perianal pain (4.88%), bleeding (7.32%), and urinary retention (4.88%) complications in the observation group had no significant difference from that in the control group [postoperative fever (5.00%), anal pain (7.50%), bleeding (7.50%), and urinary retention (2.50%)] (all P>0.05). Two months after surgery, the rebleeding rate in the observation group (4.88%) was not significantly different from that in the control group (7.50%) ( P>0.05), but the rebleeding score in the observation group (1.21±0.63) was lower than that in the control group (2.62±0.71), with a statistically significant difference ( P<0.05). The rebleeding rate (2.44%) and the rebleeding score (2.33±1.51) in the observation group were lower than those in the control group [the rebleeding rate (12.50%) and the rebleeding score (5.54±2.42)] at 12 months after follow-up, and the differences were statistically significant ( P<0.05). Conclusions:Endoscopic sclerotherapy is effective in the treatment of grade II hemorrhagic internal hemorrhoids. There is no significant difference in the immediate and short-term hemostasis rate and the incidence of complications between two different dosage forms of sclerotherapy, namely, polycinnamol solution and foam, but the operation of the solution injection is more time-saving and the long-term recurrence rate is lower, which is worthy of clinical application.

Niños andinos con quiste óseo aneurismático tratados con polidocanol (uso fuera de etiqueta) / Andean children with aneurysmal bone cyst treated with polidocanol (use off-label)

Resumen: 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.

Abstract: 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 and 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.

Polydocanol percutaneous sclerotherapy for the treatment of giant venular malformation of the lips and cheeks in adults / 口腔疾病防治

Objective @#To investigate the clinical effect of polidocanol sclerotherapy in the treatment of giant venular malformations of the lips and cheeks in adults.@*Methods@# From September 2019 to September 2020, 5 patients with huge venular malformations of the lips and cheeks (4 males, 1 female) admitted to Xuzhou Central Hospital were included in the study. All the patients were treated with local injection of polidocanol foam scleroagent, and all patients were followed up with a 3-week treatment course. If the clinical symptoms were not alleviated and the MRI examination showed that > 25% of the lesion remained, or it relapsed again after symptoms are stable, the patient needed to be treated again. The endpoints of treatment were: ①subsidence of clinical symptoms and MRI showing residual lesions < 25% in size; ②continuous treatment for 4 times without relief or aggravation of symptoms; ③a discontinuation of treatment. @* Results@#All 5 patients successfully completed the treatment and were injected 2 to 4 times during treatment. The curative effect was evaluated according to the Achauer standard, including grade Ⅰcurative effects in 1 patient, grade Ⅱ in 2 patients, grade Ⅲ in 2 patients. Among them, one patient suffered from erosion and bleeding in the lesion before the operation, and the symptoms were significantly improved postoperatively. No serious side effects were found except skin pigmentation in 1 case. @*Conclusion@#Local injection of polidocanol foam scleroagent is a safe and effective treatment method for adult giant venular malformations of the lips and cheeks, and it has a hemostatic effect on spontaneous bleeding invenular malformations.

Efficacy of foam sclerotherapy in treatment of grade I and grade II bleeding hemorrhoids at Nalanda Medical College and Hospital, Patna

Background: Sclerotherapy is the treatment of choice for first and second grade haemorrhoidal disease. The aim of this study is to assess the efficacy and safety of polidocanol foam for haemorrhoidal disease.Methods: A total of 50 patients were treated with foam sclerotherapy (polidocanol 3%). Patients who presented with complain of bleeding per anum and diagnosed with first and second grade hemorrhoidal disease were included. Patients without bleeding per anum were not included. The primary objective was the stopping of perianal bleeding after one sclerotherapy session. Sclerotherapy was repeated at 2-week intervals until patients were free of bleeding. The final follow-up was 12 weeks after the last sclerotherapy session.Results: After one foam sclerotherapy session, 82% of patients (41 out of 50) were treated successfully. After second sclerotherapy, 98% of the patients (46 out of 50) were treated successfully. 2% of the patients received third sclerotherapy.Conclusions: In the treatment of first and second grade haemorrhoidal disease, polidocanol 3% foam is very effective and safe. The results of this study show that foam sclerotherapy is a new, innovative, effective and safe non-surgical treatment option for haemorrhoidal disease.

Tratamento de linfocele mediante ecoescleroterapia com polidocanol: relato de casos e revisão / Polidocanol echosclerotherapy treatment for lymphocele: case report and review

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.

Tratamiento de hemangioma lingual con polidocanol al 0.5 %. Relato de caso clínico. / Treatment of lingual hemangioma with 0.5% polidocanol. Clinical case report

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

Advances in intralesional injections for infantile hemangioma / 中华整形外科杂志

Intralesional injection is a common method among various therapeutic choices for the treatment of Infantile Hemangiomas. This article reviews the clinical application of intralesional injections for infantile hemangiomas, discusses indications for intralesional injection treatment and evaluates the safety and efficacy of different injected drugs.

Polidocanol versus alcohol absoluto como sustancias esclerosantes en modelo experimental animal / Polidocanol versus absolute alcohol as sclerosing substances in experimental animal model

Introducción: La esclerosis se caracteriza por la destrucción celular epitelial con apoptosis, inflamación estéril, fibrosis irreversible y disminución de la masa tisular por retracción con subsecuente obliteración de la luz de los quistes y/o vasos sanguíneos. Existen diferentes sustancias esclerosantes que pueden ser utilizados. Aun así, actualmente no se han definido pautas claras en el manejo con sustancias esclerosantes. Esto puede considerarse como un tratamiento poco invasivo y efectivo. Objetivo: Determinar la eficacia y seguridad del polidocanol versus alcohol absoluto como sustancias esclerosantes en modelo experimental animal. Materiales y Métodos: El estudio se realizó con 34 ratas, distribuidas en forma aleatoria en 3 grupos. Grupo A con 16 ratas a las cuales se les introdujo 1 ml de polidocanol intravesical. Grupo B con 16 ratas a las que se les introdujo 1 ml de alcohol absoluto intravesical. Grupo C (control) con 2 ratas sin intervención. Las 2 ratas del grupo control fueron sacrificadas con sobredosis de halotano. Igualmente las ratas de cada grupo experimental, que fueron sacrificadas en pares, escogidos al azar, a las 12, 24, 48, 72, 96 y 120 horas post aplicación respectivamente. Luego se realizó el estudio anatomopatológico. Se verificó la profundidad y extensión de la esclerosis y se adjudicó puntaje según escala numérica previamente diseñada. Se determinó y comparó la eficacia y seguridad de ambas sustancias dependiendo de la extensión y profundidad de la esclerosis según el tiempo de acción con regresión logística y test exacto de Fisher. Resultados: Ambas sustancias mostraron similar efectividad al producir esclerosis con retracción de la pared vesical en 100% de los casos después de 24 horas de aplicación. El polidocanol mostró acción biológica progresiva encontrándose correlación entre el tiempo de acción y la profundidad de la esclerosis mediante el análisis de regresión logística con coeficiente de correlación de 0.75 e índice de probabilidad: 0.00183 (p < 0.05). El alcohol absoluto produjo esclerosis profunda inmediata, sin correlación con el tiempo de acción, con coeficiente de correlación de - 0.0465 con un índice de probabilidad de 0.864 (p > 0.05). Se estimó la seguridad de las sustancias según el hallazgo de esclerosis transmural y lesión de órganos vecinos. En ningún caso con polidocanol (0%) hubo paso transmural ni lesión de órganos vecinos mientras que en 83,33% de los casos del alcohol absoluto se presentó esclerosis transmural con lesión de órganos adyacentes en 50% de los casos (Test de Fisher's p < 0.0001 extremadamente significativo). Ninguna de las 2 sustancias produjo lesiones de órganos a distancia. Conclusiones: Tanto el alcohol como el polidocanol son efectivos para generar esclerosis. La esclerosis con polidocanol impresiona ser segura por quedar limitada a la vejiga. La escleroterapia con alcohol no parece ser segura porque genera esclerosis transmural y lesión de órganos contiguos. La diseminación de las sustancias a través de vasos sanguíneos o linfáticos con lesiones de órganos distantes no ocurrió en ningún caso y parece improbable ya que los esclerosantes producen la oclusión de estos vasos.

Introduction: Sclerosis is characterized by epithelial cell destruction with apoptosis, sterile inflammation, irreversible fibrosis and decreased tissue mass by retraction with subsequent obliteration of the lumen of the cysts and / or blood vessels. There are different sclerosing substances that can be used. Even so, clear guidelines have not yet been defined in the management of sclerosing substances. This can be considered as a minimally invasive and effective treatment. Objective: To determine the efficacy and safety of polidocanol versus absolute alcohol as sclerosing substances in an experimental model. Materials and Methods: The study was conducted with 34 rats, randomly distributed in 3 groups. Group A with 16 rats to which 1 ml of intravesical polidocanol was introduced. Group B with 16 rats to which 1 ml of intravesical absolute alcohol was introduced. Group C (control) with 2 rats without intervention. The 2 rats of the control group were sacrificed with halothane overdose. Also the rats of each experimental group, which were sacrificed in pairs, chosen at random, at 12, 24, 48, 72, 96 and 120 hours after application respectively. Then the anatomopathological study was carried out. The depth and extension of the sclerosis was verified and a score was awarded according to a previously designed numerical scale. The efficacy and safety of both substances were determined and compared depending on the extension and depth of the sclerosis according to the time of action with logistic regression and Fisher's exact test. Results: Both substances showed similar effectiveness in producing sclerosis with retraction of the bladder wall in 100% of the cases after 24 hours of application. The polidocanol showed progressive biological action, finding a correlation between the time of action and the depth of the sclerosis by means of the logistic regression analysis with a correlation coefficient of 0.75 and a probability index of 0.00183 (p <0.05). Absolute alcohol produced immediate deep sclerosis, without correlation with the time of action, with a correlation coefficient of - 0.0465 with a probability index of 0.864 (p> 0.05). The safety of the substances was estimated according to the finding of transmural sclerosis and injury to close organs. In no case with polidocanol (0%) there was transmural passage or injury of close organs, while in 83.33% of cases of absolute alcohol, transmural sclerosis with lesion of adjacent organs occurred in 50% of the cases (Fisher's Test p <0.0001 extremely significant). None of the 2 substances produced remote organ injuries. Conclusions: Both alcohol and polidocanol are effective in generating sclerosis. Sclerosis with polidocanol is safe because it is limited to the bladder. Sclerotherapy with alcohol does not appear to be safe because it generates transmural sclerosis and injury to contiguous organs. The dissemination of the substances through blood or lymphatic vessels with lesions of distant organs did not occur in any case and seems unlikely since the sclerosants produce the occlusion of these vessels

Comparison of Local Sclerotherapy With Lauromacrogol Versus Nasal Packing in the Treatment of Anterior Epistaxis

OBJECTIVES: Epistaxis is one of the most common otorhinolaryngologic emergencies representing more than 12% of conditions managed at the Ear, Nose and Throat (ENT) Emergency Consulting Room of our Otorhinolaryngologic Unit each year. The elevated frequency of this pathology makes it necessary to adopt the most effective and least expensive therapeutic strategy available. The aim of this study was to compare the efficacy, costs and morbidity of nasal packing (NP), which is the mainstay of treatment for anterior epistaxis in our ENT Emergency Consulting Room versus submucosal infiltrations of lauromacrogol (LA). METHODS: A retrospective study was designed from August 2012 to April 2013 involving 53 patients suffering from anterior epistaxis. Anterior NP was used in 27 patients versus 26 patients undergoing 27 procedures performed with submucosal infiltrations of LA (or polidocanol). Outcomes for each treatment were evaluated. Patients in group 1 were treated with LA 400 injection next to the bleeding point: 0.5- to 1-mL single or multiple infiltrations with a 27-gauge needle. The whitening of the nasal mucosa around the bleeding point during infiltration was considered a marker of correct procedure in order to achieve the best results. Bilateral treatment was also performed at the same time. Patients in group 2 were treated with standard NP. RESULTS: Bleeding recurrence was higher in the NP group even if it was not statistically significant (P=0.2935). However, the LA infiltrations were better tolerated with lower morbidity and costs as compared to NP. No complications were observed in either group. CONCLUSION: LA infiltrations were shown to be a viable alternative in anterior epistaxis treatment. They are safe, easy to use with good efficacy and have a low cost.