Transient adverse events positively associated with patent foramen ovale after ultrasound-guided foam sclerotherapy

2009 ◽  
Vol 24 (3) ◽  
pp. 114-119 ◽  
Author(s):  
Pauline Raymond-Martimbeau
Keyword(s):  
Adverse Events ◽  
Sensitivity And Specificity ◽  
Patent Foramen Ovale ◽  
Varicose Veins ◽  
High Sensitivity ◽  
Foramen Ovale ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Phone Calls

Objectives To prospectively study the association between patent foramen ovale (PFO) detected by contrast transcranial Doppler (cTCD) and adverse events (AEs) reported by patients after ultrasound-guided foam sclerotherapy (UGFS) for the treatment of varicose veins. Methods All patients reporting AEs after UGFS were studied using cTCD directed at the middle cerebral artery to determine the Spencer grading score by counting high-intensity transient signals. Agitated saline was used as the contrast medium. The Spencer grading score determined the presence or absence of PFO. All patients undergoing UGFS received follow-up phone calls within 24 hours and again two weeks after the procedure. Results Of the 3259 patients who underwent UGFS, AEs were reported by seven (0.21%) patients at their first session. These included visual disturbance, migraine and chest discomfort. Five (71.4%) of these seven patients tested positive for PFO by cTCD. The two-week follow-up confirmed no permanent symptoms. Published studies show high sensitivity and specificity for cTCD when compared with contrast transesophageal echocardiography (cTEE). Conclusions The overall rate of AEs reported is consistent with published results. The presence of a PFO was detected in most patients reporting AEs after undergoing UGFS. While PFO screening with high sensitivity and specificity can be performed efficiently in the clinic setting, based on the literature, further investigation is warranted.

scholarly journals Transcatheter Patent Foramen Ovale Closure Guided Only by Transesophageal Echocardiography Without fluoroscopy

2020 ◽  
Author(s):  
Tianli Zhao ◽  
Qin Wu ◽  
Hendrik Ruge ◽  
Rüdiger Lange ◽  
Yifeng Yang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Clinical Experiences ◽  
Serious Adverse Events ◽  
Ischemic Attack ◽  
Pfo Closure

Abstract Background Standby of transesophageal echocardiography (TEE) is necessary for any PFO closure in case of some cases with complicated anatomy of patent foramen ovale (PFO). The safety and effectiveness of Transcatheter PFO closure guided only by TEE navigation without fluoroscopy is unclear.Methods From 2017.06 to 2019.11, we included 38 patients who were recommended for PFO closure by the department of neurology at our hospital. The procedure was performed in a regular operating room by TEE navigation without fluoroscopy. Follow-up was given at 1st month, 3rd month, 6th month, 1st year and 2nd year after operation for each patient.Results All 38 patients were successfully performed PFO-closure guided by TEE. Procedural and intrahospital survival was 100%. Survival after a mean follow-up of 17.1±1.6months was 100%. "Catheter in sheath” technique was adopted in 16 cases. After the procedure, all 28 migraines with aura alleviated at different degree. All 10 patients suffering from pre-operational cryptogenic stroke survived and showed no evidence for recurrence of stroke (fatal or non-fatal), peripheral embolism or transient ischemic attack during follow-up. No serious adverse events in the PFO closure procedure and during the follow-up period.Conclusion First clinical experiences showed that percutaneous TEE guided PFO closure is safe and effective and might be promoted.

Late stroke after foam sclerotherapy

VASA ◽  
2010 ◽  
Vol 39 (1) ◽  
pp. 108-110 ◽  
Author(s):  
Hahn ◽  
Schulz ◽  
Jünger
Keyword(s):  
Ischemic Stroke ◽  
Female Patient ◽  
Patent Foramen Ovale ◽  
Varicose Veins ◽  
Late Complication ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Foam Sclerotherapy ◽  
The Third

Foam sclerotherapy is a safe, effective and increasingly widespread method of treating varicose veins. A case of ischemic stroke is described with reversible symptoms five days after polidocanol foam sclerotherapy was repeated in a 48-year-old female patient with a patent foramen ovale that was undetected at the time of sclerotherapy. The first foam sclerotherapy treatment had been tolerated well without complications. While acute neurological events immediately after sclerotherapy for varicose veins have been described repeatedly in the literature, this report is only the third case described worldwide of paradoxical embolism as a possible late complication of foam sclerotherapy for varicose veins.

Management of venous malformations in Klippel–Trenaunay syndrome with ultrasound-guided foam sclerotherapy

2005 ◽  
Vol 20 (2) ◽  
pp. 63-81 ◽  
Author(s):  
B McDonagh ◽  
S Sorenson ◽  
A Cohen ◽  
T Eaton ◽  
D E Huntley ◽  
...  
Keyword(s):  
Varicose Veins ◽  
Venous Malformation ◽  
Limb Lengthening ◽  
Venous Malformations ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
History Of ◽  
Deep Vein ◽  
Klippel Trenaunay Syndrome

Objective: To study the clinical profile of Klippel–Trenaunay syndrome (KTS) and the management of venous malformations (VMs) with ultrasound-guided foam sclerotherapy using the compass technique. Methods: In this open prospective series, 11 consecutive patients with KTS seeking therapy at a phlebology group practice were included. Seven (64%) of them were post-surgical recurrences. Results: Pain was the commonest presenting complaint (100%), accompanied with VMs/ varicose veins in all except one (91%). Chronic venous insufficiency (CVI) was seen in seven (64%). Soft tissue and bone deformity was present in all (100%). Limb lengthening was frequent and detected in eight (73%), thickening in six (54%); unusually, one patient (9%) presented with severe thinning and shortening of the leg. Venous malformation was the primary vascular problem in nine patients (82%), with capillary malformation (CM)/port wine stain in seven (64%) and isolated lymphatic malformation (LM) in two (18%). The lateral embryonic/Klippel–Trenaunay (KT) vein was detected in 10 patients (91%). Deep vein deformity was not detected in any of them. All the deformities were of the lower limb (100%), while two (18%) had deformities of the thorax and one (9%) had gastrointestinal (GI) malformation. None of the patients gave family history of KTS, while five (45%) had history of varicosities in the family. Eight patients (73%) completed the therapeutic plan with a mean follow-up of 5±3.9 years. An excellent to good type result could be documented in six of the eight cases (75%). These patients had an event-free, good quality of life. Follow-up duplex studies revealed the evolving refluxing tracts requiring sequential therapies. Conclusions: The results in this series demonstrate the utility of foam sclerotherapy using the compass technique in the management of KTS. Chronicity of the VMs in KTS necessitates strict clinical monitoring and sequential therapies.

scholarly journals Ultrasound-guided perisaphenous tumescence infiltration improves the outcomes of long catheter foam sclerotherapy combined with phlebectomy of the varicose tributaries

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Attilio Cavezzi ◽  
Giovanni Mosti ◽  
Sonia Di Paolo ◽  
Lorenzo Tessari ◽  
Fausto Campana ◽  
...  
Keyword(s):  
Observational Study ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Arbitrary System ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Group I ◽  
Diseased Segment ◽  
Occlusion Rate

A prospective comparative observational study was performed to assess the short--term efficacy and safety of the peri-saphenous infiltration of tumescence solution (PST) in great saphenous vein (GSV) long catheter foam sclerotherapy (LCFS) combined with phlebectomy of the varicose tributaries. Since November 2006 through November 2010 fifty-one consecutive patients (16 males and 35 females, mean age 51.5 years) who underwent LCFS of GSV + multiple phlebectomies were prospectively enrolled, without any pre-selection criteria, in three different groups (17 patients per group) and reviewed as to their outcomes: i) patients without additional PST; ii) with PST under visual control; iii) with ultrasound-guided PST. All procedures were performed in local anesthesia and an average of 7 mL [interquartile range (IQR) 6.5-7.5] of 3% sodiumtetradecylsulfate CO2+O2-based sclerosant foam was injected in the diseased segment of GSV (median caliber 7) (IQR 6-8) by means of a 4F long catheter. Clinical and color-duplex ultrasound (CDU) follow-up was performed at regular intervals, the last of which 14 months after the treatment. At 14 months follow-up no varicose veins were visible in 94%, 94% and 100% of the cases in group I, II and III respectively. The CDUbased outcomes were the following: 71%, 71% and 84% GSV occlusion rate in group I, II and III respectively; reflux was found in 5, 4 and 1 cases in group I, II and III respectively. Clinical and CDU morphologic and hemodynamic results were assembled and scored through an arbitrary system. The relative statistical analysis showed a significant (P<0.0001) improvement of the results for patients who received ultrasound guided PST over the other two groups. No relevant complications were recorded in all 51 cases. GSV treatment by means of LCFS + phlebectomy of varicose tributaries proved to be effective and safe in this prospective observational study. The addition of ultrasound guided PST resulted in a significant improvement of GSV occlusion rate and of varicose vein clinical resolution.

scholarly journals Cerebrovascular ischemia following ultrasound-guided foam sclerotherapy

2018 ◽  
Vol 17 (4) ◽  
pp. 333-336 ◽  
Author(s):  
Agamenon Hülse Bittencourt ◽  
Daniela Vianna Dallanora ◽  
Nelson Rafael Bacega ◽  
Vinicius Saul Cembranel
Keyword(s):  
Cerebral Ischemia ◽  
Allergic Reaction ◽  
Varicose Veins ◽  
Healthy Woman ◽  
Great Effort ◽  
Broca’S Area ◽  
Foramen Ovale ◽  
Broca's Area ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy

Abstract Cerebral ischemia is a very rare and harmful complication of ultrasound-guided foam sclerotherapy for treatment of varicose veins. This case describes a documented cerebrovascular ischemia in Broca’s area following ultrasound-guided foam sclerotherapy. Less than one hour after intravenous injection of 10 ml of sclerosing foam, an otherwise healthy woman experienced aphasia without any other signs of neurological changes. When she arrived home, a complete inability to talk was observed. The event was misdiagnosed by another doctor as an allergic reaction. Next morning she came to the office to report the allergic reaction, where an appropriate diagnosis was made. She recovered just two days after the injection, but signs of recent cerebral ischemia were seen in Broca’s area on magnetic resonance and transesophageal bubble study echocardiogram revealed a patent foramen ovale. Although rare, we must make great effort to prevent these events instead of treating them.

Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux

2009 ◽  
Vol 24 (4) ◽  
pp. 183-188 ◽  
Author(s):  
P Chapman-Smith ◽  
A Browne
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Adverse Outcomes ◽  
Patient Acceptance ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Clinical Recurrence ◽  
Over Time

Objectives The purpose of this study was to determine the long-term efficacy, safety and rate of recurrence for varicose veins associated with great saphenous vein (GSV) reflux treated with ultrasound-guided foam sclerotherapy (UGFS). Methods A five-year prospective study was performed, recording the effect on the GSV and saphenofemoral junction (SFJ) diameters, and reflux in the superficial venous system over time. UGFS was the sole treatment modality used in all cases, and repeat UGFS was performed where indicated following serial annual ultrasound. Results No serious adverse outcomes were observed – specifically no thromboembolism, arterial injection, anaphylaxis or nerve damage. There was a 4% clinical recurrence rate after five years, with 100% patient acceptance of success. Serial annual duplex ultrasound demonstrated a significant reduction in GSV and SFJ diameters, maintained over time. There was ultrasound recurrence in 27% at 12 months, and in 64% at five years, including any incompetent trunkal or tributary reflux even 1 mm in diameter being recorded. Thirty percent had pure ultrasound recurrence, 17% new vessel reflux and 17% combined new and recurrent vessels on ultrasound. Of all, 16.5% required repeat UGFS treatment between 12 and 24 months, but less than 10% in subsequent years. The safety and clinical efficacy of UGFS for all clinical, aetiological, anatomical and pathological elements classes of GSV reflux was excellent. Conclusion The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms. Patients accept that UGFS can be repeated readily if required for recurrence in this common chronic condition. The subclinical ultrasound evidence of recanalization or new vein incompetence needs to be considered in this light.

Abstract WP264: Frequency of Hypercoagulability in Patients With Embolic Stroke of Undetermined Source and Patent Foramen Ovale

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael Liu ◽  
Srikant Rangaraju ◽  
Alexander Duncan ◽  
Samir Belagaje ◽  
Trina Belair ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Embolic Stroke ◽  
Composite Outcome ◽  
Foramen Ovale ◽  
Primary Mechanism ◽  
Detailed Evaluation ◽  
D Dimer

Introduction: Patent foramen ovale (PFO) is more commonly found in patients with cryptogenic stroke and paradoxical embolism is commonly assumed to be the primary mechanism. Our objective was to determine the frequency of hypercoagulability in cryptogenic stroke patients and PFO. Methods: Consecutive patients with embolic stroke of undetermined source (ESUS) seen at the Emory Clinic from January 1, 2017 to June 30, 2019 who underwent echocardiogram with bubble study and markers of coagulation and hemostatic activation (MOCHA) testing (serum d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) were included; abnormal MOCHA was defined as ≥ 2 elevated markers. Venous thromboembolism, malignancy, other defined hypercoagulable state, and the composite outcome were assessed at routine follow-up and compared across groups based on PFO status. Results: Of 172 patients (mean age 63 ± 16 years, 60% female), 40 (23%) had a PFO. Compared to the PFO- group, the PFO+ group was younger (p=<0.001), less likely to have hypertension (p<0.001) and diabetes (p=0.011), and had a higher ROPE score (p=0.007) (Table 1). There was no difference in the frequency of abnormal MOCHA between groups and the composite outcome was less frequent in PFO+ versus PFO- patients (p=0.017). In the subgroup of patients <60 years old, there was no difference in the frequency of abnormal MOCHA and the composite outcome. Conclusion: Hypercoagulability as measured by MOCHA was not associated with the presence of PFO in ESUS patients. Based on our results, ESUS patients should undergo a detailed evaluation for alternative causes of stroke other than paradoxical embolism.

Sign in / Sign up

Export Citation Format

Share Document