| Clinical significance of cerebrovascular gas emboli during polidocanol endovenous ultra-low nitrogen microfoam ablation and correlation with magnetic resonance imaging in patients with right-to-left shunt. | |
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MedLine Citation:
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PMID: 20864303 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Foam generated by manual agitation of liquid sclerosant with air or gas is routinely utilized to treat refluxing veins. Although generally well tolerated, serious neurological events have been reported. The composition and properties of the foam, including bubble size and gaseous components, may contribute to the potential for microcirculatory obstruction and cerebral ischemia. We tested an ultra-low nitrogen polidocanol endovenous microfoam with controlled bubble size and density and hypothesized that patients at risk due to the presence of middle cerebral artery (MCA) bubble emboli during microfoam injection would not demonstrate evidence of clinical or subclinical cerebral infarction. METHODS: Patients with great saphenous vein incompetence were treated with ultra-low nitrogen (≤ 0.8%) polidocanol endovenous microfoam injected under ultrasound guidance. Patients with right-to-left shunt were included to evaluate the safety of cerebral arterial bubbles. All patients with MCA emboli detected by transcranial Doppler during endovenous microfoam ablation received intensive surveillance for microinfarction, including brain magnetic resonance imaging and measurement of cardiac troponin-I. RESULTS: MCA bubble emboli were detected in 60 of 82 treated patients; 22 patients had no detectable emboli. Among patients with MCA bubbles detected, 49 (82%) had ≤ 15 bubbles. No patients developed magnetic resonance imaging abnormalities, neurological signs, or elevated cardiac troponin. CONCLUSIONS: Patients treated with foamed liquid sclerosants are commonly exposed to cerebrovascular gas bubbles. In this series of 60 high-risk patients with MCA bubble emboli during or after treatment with ultra-low nitrogen polidocanol endovenous microfoam, there was no evidence of cerebral or cardiac microinfarction. The results of this study cannot be generalized to foams compounded using bedside methodologies, since the composition of these foams is substantially different. |
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Authors:
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John D Regan; Kathleen D Gibson; Janet E Rush; Cynthia K Shortell; Stanley A Hirsch; David D I Wright |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2010-09-22 |
Journal Detail:
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Title: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter Volume: 53 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-27 Completed Date: 2011-01-31 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 131-7 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Wake Forest University School of Medicine, Winston-Salem, NC, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Cerebral Infarction / diagnosis, epidemiology* Embolism, Air / epidemiology* Endovascular Procedures Female Humans Intracranial Embolism / epidemiology* Magnetic Resonance Imaging Male Middle Aged Middle Cerebral Artery Myocardial Infarction / diagnosis, epidemiology Polyethylene Glycols / administration & dosage* Saphenous Vein* Sclerosing Solutions / administration & dosage* Sclerotherapy / adverse effects, methods* Ultrasonography, Doppler, Duplex Ultrasonography, Doppler, Transcranial Ultrasonography, Interventional Varicose Veins / therapy*, ultrasonography Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Polyethylene Glycols; 0/Sclerosing Solutions; 9002-92-0/polidocanol |
| Comments/Corrections | |
Comment In:
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J Vasc Surg. 2011 Jan;53(1):137-8
[PMID:
21184934
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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