Myocardial infarction after ultrasoundguided foam sclerotherapy for varicose veins - a case report and review of the literature of a rare but serious adverse event

Engelberger, Rolf P.; Ney, Barbara; Clair, Mathieu; Dabiri, Amin; Alatri, Adriano; Mazzolai, Lucia; Kern, Philippe

doi:10.1024/0301-1526/a000534

Cited by 9 publications

(8 citation statements)

References 23 publications

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“…20 A feeling of chest pressure or tightness has been reported after sclerotherapy, and it is usually rapidly resolved. 21 In a large prospective cohort study, chest pressure was reported in 1.1% in patients treated with UGCDFS. 22 According to Morrison et al., 23 chest tightness was more frequent when large foam volumes (>15 ml) were injected.…”

Section: Discussionmentioning

confidence: 99%

“…24 In our study, the average volume of foam sclerosant was 12 ml (range, 10-15 ml), and chest pressure for a few seconds after procedure was seen in 1.3% of patients. Engelberger et al 21 reported a case in which they used 12 ml of 1% polidocanol foam where a 78year-old patient had a heart attack following UGCDFS. In our study, the average age in group 1 was 69.6 AE 4.5 (65-89), and chest pressure was not associated with cardiac symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Engelberger et al. 21 reported a case in which they used 12 ml of 1% polidocanol foam where a 78-year-old patient had a heart attack following UGCDFS. In our study, the average age in group 1 was 69.6 ± 4.5 (65–89), and chest pressure was not associated with cardiac symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided catheter-directed foam sclerotherapy can be safely applied for the treatment of great saphenous varicose veins in elderly patients

Kahraman

Özsin

2020

Vascular

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Objectives Although many published series have shown the results of ultrasound-guided catheter-directed foam sclerotherapy, little is known about the outcomes and complications in older patients. Methods A total of 152 patients older than 65 years (group 1: 61.8% male, mean age 69.0 ± 4.5 years) and 244 patients younger than 65 years (group 2: 48.8% male, mean age 45.7 ± 11.2 years) were included in the study. Ultrasound-guided catheter-directed foam sclerotherapy was performed in patients with great saphenous vein valvular incompetence and saphenofemoral junction incompetence. Occlusion status was recorded by ultrasonography. Venous clinical severity score and visual analog score were calculated pre- and post-intervention. Results Complete occlusion rate of the great saphenous vein at 12 months post-procedure for the groups 1 and 2 was 86.4% and 86.3%, respectively. Venous clinical severity score and visual analog score were signiﬁcantly different before ultrasound-guided catheter-directed foam sclerotherapy and four weeks after ultrasound-guided catheter-directed foam sclerotherapy ( p < 0.001) in both the groups. There were no observed major complications in both the groups. Conclusions With low complication rate and acceptable total occlusion rate, ultrasound-guided catheter-directed foam sclerotherapy can be considered a reliable treatment for older patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided catheter-directed foam sclerotherapy can be safely applied for the treatment of great saphenous varicose veins in elderly patients

Kahraman

Özsin

2020

Vascular

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“…10,11 Further cases have been reported of myocardial infarction after foam sclerotherapy with aethoxysklerol or sodium tetradecylsulphate. [9][10][11] The difficulty of assessing these latter cases as to whether they constitute a reaction to the sclerosant or the gas bubbles in the foam is the inconsistency of reporting which detergent was used and in what concentration, what gas was used to make the foam and the total dose injected into which veins.…”

Section: Discussionmentioning

confidence: 99%

“…Reports of cardiac arrest in children where high doses of aethoxysklerol were injected into venous malformations also seem to point towards a direct cardiotoxicity of the drug, 6,7 as does a report of a 48-year-old lady who underwent cardiac arrest following the injection of '7-mL foam polidocanol injection'. 8 Polidocanol foam sclerotherapy has also been reported to cause myocardial infarction in a 78-year-old patient, 9 but myocardial infarction with foam sclerotherapy has been reported with foam made from both aethoxysklerol and sodium tetradecyl sulphate. 10,11 Further cases have been reported of myocardial infarction after foam sclerotherapy with aethoxysklerol or sodium tetradecylsulphate.…”

Section: Discussionmentioning

confidence: 99%

Clinical dilemma of management: Cardiac arrest after microsclerotherapy for lower limb telangiectasia with liquid 0.3% aethoxysklerol or idiopathic cardiac arrest?

Whiteley

Taylor

King

et al. 2021

SAGE Open Medical Case Reports

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A 48-year-old woman attended to discuss a dilemma. She had suffered a cardiac arrest immediately following microsclerotherapy of leg telangiectasia with 0.3% aethoxysklerol. She had successful defibrillation and been transferred to hospital. In hospital, despite normal cardiac tests, she was diagnosed as having idiopathic cardiac arrest. The exposure to aethoxysklerol was discounted by her cardiologists as a cause of her arrest. Following the hospital protocol, she was strongly advised to have an implantable defibrillator. Cardiac arrest and myocardial infarction are documented after aethoxysklerol injection with proposed mechanisms being anaphylaxis, direct cardiotoxicity or endothelin-1 release. Before consenting to an implantable defibrillator, which may have its own complications in the long term, doctors and the patient need to be certain that this arrest was not due to a reaction to aethoxysklerol.

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Sclerotherapy for Reticular Veins in the Lower Limbs

et al. 2017

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IMPORTANCE Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant.OBJECTIVE To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2). DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs. INTERVENTIONSThe patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins. MAIN OUTCOMES AND MEASURESThe primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas).RESULTS Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P < .001). No serious adverse events occurred in either group. Pigmentation was the most common minor adverse event, with a 3.53% treated-vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09).CONCLUSIONS AND RELEVANCE Sclerotherapy with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone in sclerosing reticular veins, with no statistical difference for complications. Pigmentation occurred in both groups, with no statistical difference between them. No serious adverse events occurred in either group. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02054325

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Myocardial infarction after ultrasoundguided foam sclerotherapy for varicose veins - a case report and review of the literature of a rare but serious adverse event

Abstract: Key message: The possibility of potentially serious cardiac complications after sclerotherapy for varicose veins has to be kept in mind. Chest symptoms lasting longer than 5 minutes or with typical features of acute coronary syndrome have to be investigated.

Cited by 9 publications

References 23 publications

Ultrasound-guided catheter-directed foam sclerotherapy can be safely applied for the treatment of great saphenous varicose veins in elderly patients

Ultrasound-guided catheter-directed foam sclerotherapy can be safely applied for the treatment of great saphenous varicose veins in elderly patients

Clinical dilemma of management: Cardiac arrest after microsclerotherapy for lower limb telangiectasia with liquid 0.3% aethoxysklerol or idiopathic cardiac arrest?

Sclerotherapy for Reticular Veins in the Lower Limbs

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