Hill Douglas A
The Vein Treatment Centre, Calgary, Alberta, Canada
Phlebology. 2014 Oct;29(9):619-27. doi: 10.1177/0268355513499017. Epub 2013 Aug 14.
Documentation and analysis of adverse neurological and chest symptoms in a large single centre series of sclerotherapy treatments.
In this retrospective study, patient-reported adverse events occurring during liquid or foam sclerotherapy were recorded over a 30 month period and subsequently analyzed. The relevant patient records were reviewed to determine patient characteristics, treatment details and results of subsequent investigations.
A total of 1744 ultrasound guided sclerotherapy treatments were performed during the study period. Almost all treatments were done with air-based sodium tetradecyl sulphate foam. During the same time period, 6504 direct vision surface vein sclerotherapy treatments were completed. Approximately 1/4 of these utilized air-based foam in varying concentrations. There were 14 adverse events in 14 patients involving neurological or chest symptoms for an incidence of 0.17%. Five patients injected with foam complained of isolated chest discomfort, tightness or shortness of breath. Nine patients reported various brief neurological symptoms. These events occurred with both liquid and foam, although the majority involved foam. More neurological events were associated with direct vision sclerotherapy of smaller superficial veins than with ultrasound guided injection of intrafascial truncular veins. Seven patients who experienced neurological symptoms had a history of migraine. Five of the patients who had neurological events were investigated for right to left shunts and found to be positive.
These events were uncommon and brief. The incidence of neurological and chest symptoms was higher with foam sclerotherapy than with liquid. A history of migraine with aura was associated with an increased risk of post-treatment neurological symptoms. Events occurred with both large vein and small vein treatment. Some events were associated with liquid sclerotherapy rather than foam and with carbon dioxide based foam as well as air foam. There were no long-term adverse consequences.
记录并分析在一个大型单中心硬化治疗系列中出现的不良神经和胸部症状。
在这项回顾性研究中，记录了在30个月期间液体或泡沫硬化治疗过程中患者报告的不良事件，并随后进行了分析。审查相关患者记录以确定患者特征、治疗细节和后续检查结果。
在研究期间共进行了1744次超声引导下的硬化治疗。几乎所有治疗均使用基于空气的十四烷基硫酸钠泡沫。在同一时期，完成了6504次直视下浅表静脉硬化治疗。其中约四分之一使用了不同浓度的基于空气的泡沫。14名患者出现了14起涉及神经或胸部症状的不良事件，发生率为0.17%。5名注射泡沫的患者抱怨有孤立的胸部不适、紧绷感或呼吸急促。9名患者报告了各种短暂的神经症状。这些事件在液体和泡沫治疗中均有发生，尽管大多数与泡沫有关。与超声引导下筋膜内主干静脉注射相比，更多的神经事件与较小浅表静脉的直视硬化治疗有关。7名出现神经症状的患者有偏头痛病史。5名发生神经事件的患者接受了右向左分流检查，结果呈阳性。
这些事件不常见且短暂。泡沫硬化治疗中神经和胸部症状的发生率高于液体治疗。有先兆偏头痛病史与治疗后神经症状风险增加有关。大静脉和小静脉治疗均出现了这些事件。一些事件与液体硬化治疗而非泡沫有关，并且与基于二氧化碳的泡沫以及空气泡沫有关。没有长期不良后果。
