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Torikai H, Inoue M, Tsukada J, Togawa K, Yamamoto Y, Hase M, Tamura M, Ito N, Soga S, Nakatsuka S, Jinzaki M. Comparison of foaming properties between Shirasu porous glass membrane device and Tessari's three-way stopcock techniques for polidocanol and ethanolamine oleate foam production: A Benchtop Study. J Vasc Interv Radiol 2022; 33:518-524.e3. [PMID: 35122940 DOI: 10.1016/j.jvir.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/27/2021] [Accepted: 01/22/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the characteristics of polidocanol (POL) and ethanolamine oleate (EO) sclerosing foams produced by a Shirasu porous glass membrane (SPGM) device with those made using a three-way stopcock (3WSC). MATERIALS AND METHODS Foam half-life times were measured in an ex vivo benchtop study. Computed tomography (CT) images of each foam were obtained over the time course, and CT texture analysis was conducted. Bubble size in each foam was measured by an optical microscope. RESULTS Median foam half-life times were longer in the SPGM group than in the 3WSC group (POL: 198 vs 166 s, p = 0.02; EO: 640 vs 391 s, p < 0.01). In CT texture analysis, median standard deviation (SD) and entropy (randomness) were lower, and median energy (uniformity) and gray-level co-occurrence matrix (GLCM) homogeneity (homogeneity) were higher in the SPGM group than in the 3WSC group (POL SD: at 30 s and 50-300 s; POL entropy: at 0-60 s; EO SD: at 0-600 s; EO entropy: at 0-460 s; POL energy: at 0-40 s; POL GLCM homogeneity: at 0-250 s; EO energy: at 0-360 s; EO GLCM homogeneity: at 0-480 s; all p < 0.05). Median bubble diameters in the SPGM group and in the 3WSC group were 69 and 83 μm (p < 0.01), respectively, in POL foam; and 36 and 36 μm (p = 0.45), respectively, in EO foam. CONCLUSION POL and EO foams had greater uniformity and longer foam half-life time when prepared with an SPGM device than with a 3WSC.
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Affiliation(s)
- Hideyuki Torikai
- Department of Radiology, Keio University School of Medicine, 35, Shinanomach, Shinjyuku-ku, Tokyo, Japan; Department of Radiology and Molecular Imaging, University of Virginia, 1215 Lee St, Charlottesville, VA
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, 35, Shinanomach, Shinjyuku-ku, Tokyo, Japan.
| | - Jitsuro Tsukada
- Department of Radiology, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, Japan
| | - Koji Togawa
- Department of Radiology, Keio University School of Medicine, 35, Shinanomach, Shinjyuku-ku, Tokyo, Japan
| | - Yosuke Yamamoto
- Department of Diagnostic Radiology, Kawasaki Municipal Hospital, 12-1 Shinkawa-dori, Kawasaki-ku, Kawasaki-shi, Kanagawa, Japan
| | - Manabu Hase
- Department of Radiology, Keio University School of Medicine, 35, Shinanomach, Shinjyuku-ku, Tokyo, Japan
| | - Masashi Tamura
- Department of Radiology, Keio University School of Medicine, 35, Shinanomach, Shinjyuku-ku, Tokyo, Japan
| | - Nobutake Ito
- Department of Radiology, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, Japan
| | - Shigeyoshi Soga
- Department of Radiology, Keio University School of Medicine, 35, Shinanomach, Shinjyuku-ku, Tokyo, Japan
| | - Seishi Nakatsuka
- Department of Radiology, Keio University School of Medicine, 35, Shinanomach, Shinjyuku-ku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomach, Shinjyuku-ku, Tokyo, Japan
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Evaluation of sclerotherapy of benign oral vascular lesions with monoethanolamine oleate. Clin Oral Investig 2020; 25:1767-1774. [PMID: 32748074 DOI: 10.1007/s00784-020-03479-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the efficacy of sclerotherapy with monoethanolamine oleate (MEO) in a series of cases of benign oral vascular lesions (BOVL). MATERIAL AND METHODS Clinical records and images were retrieved (2015-2019), and data regarding age, gender, location, size, symptomatology, treatment and outcomes of patients were collected. All patients were diagnosed according to the classification of International Society for the Study of Vascular Anomalies and received the same treatment protocol (MEO 0.05 g/mL). The collected data were submitted to descriptive analysis and Pearson's chi-square test (p ≤ 0.05). RESULTS Thirty-seven patients were treated. Most were female (70.3%) aged 9 to 88 years (median, 57.5 ± 17.4 years). Lower lip (54.1%) was the most affected site followed by buccal mucosa (16.2%). Thirty-two lesions were asymptomatic and 35.1% showed ≤ 0.5 cm in size. In 48.6% of the patients, only one application of MEO was performed. Complete regression occurred in 62.2% of cases, whereas 27% showed partial regression. One patient showed hypersensitivity during treatment. There was no significant difference between clinical outcome and age, anatomic site, size, and number of applications of MEO. CONCLUSIONS Sclerotherapy with MEO is an acceptable and affordable treatment and can provide satisfactory results in BOVL, especially where other treatment options could compromise the esthetic aspects. CLINICAL RELEVANCE As it is a non-invasive therapy leading, in most cases, to adequate clinical results, safety, and tolerability, sclerotherapy with MEO can be considered an effective treatment for BOVL.
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Kato CN, Ribeiro MC, Abreu MH, Grossmann SD, Abreu LG, Caldeira PC, Mesquita RA. What is the preferred concentration of ethanolamine oleate for sclerotherapy of oral vascular anomalies? Med Oral Patol Oral Cir Bucal 2020; 25:e468-e473. [PMID: 32388528 PMCID: PMC7338073 DOI: 10.4317/medoral.23448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background This study compared three different concentrations of EO (1.25%, 2.5% and 5%) for the treatment of oral vascular anomalies (OVAs).
Material and Methods This was a retrospective comparative analysis of patients with OVAs treated with EO. Anomalies smaller than 20 mm were included. The patients were treated with 1.25% (G1), 2.5% (G2), and 5% (G3) and clinical data were obtained. The number of sessions, the final volume and dose of EO were statistically analyzed to verify effectiveness and safety of the treatment. The different concentrations of EO were compared considering the number of sessions, the final volume and total dose of EO. Analysis of covariance (ANCOVA) was used to evaluate the influence of covariates on the outcomes. A p-value < 0.05 was considered significant.
Results Nineteen women and 11 men with a median age of 54 years were included. The OVAs were most frequent in the lip (n=14) and cheek (n=9). All lesions exhibited complete clinical healing within 28 days. Patients of G3 required fewer sessions than those of G2 (p=0.017), a lower final volume compared to the other groups (p<0.001), and a lower total dose than G1 (p<0.001). Patients of G1 used a lower total dose than G2 (p=0.003).
Conclusions The concentration of 5% EO performed better than 1.25% and 2.5% for sclerotherapy of OVAs measuring up to 20 mm. This preliminary result should be the preferred concentration of EO to provide an effective and safe treatment of OVAs. Key words:Ethanolamine oleate, sclerotherapy, vascular malformations, hemangioma, oral mucosa.
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Affiliation(s)
- C-N Kato
- Faculdade de Odontologia UFMG Department of Oral Surgery and Pathology Av. Antônio Carlos, 6627 sala 3204, Pampulha Belo Horizonte, Minas Gerais, Brasil, 31270-901
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Zeevi I, Chaushu G, Alterman M, Chaushu L. Sclerotherapy of Vascular Malformations in the Oral Cavity-Minimizing Postoperative Morbidity. MEDICINA-LITHUANIA 2020; 56:medicina56050254. [PMID: 32456057 PMCID: PMC7279465 DOI: 10.3390/medicina56050254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022]
Abstract
Vascular malformations (VMs) are a wide vascular or lymphatic group of lesions common on the head and neck. The objective of this study was to assess the efficacy and morbidity of sclerotherapy for the treatment of VMs in the oral and perioral area. Special attention was given to factors that may contribute to minimizing postoperative morbidity. Data from 25 patients (32 lesions) with oral VMs submitted to sclerotherapy with monoethanolamine oleate (EAO) were included. A structured form was used to collect data. An arbitrary score was determined to evaluate postoperative morbidity. Each of the following signs or symptoms received one point: pain, swelling, hematoma, ulceration, erythema, transient numbness, and transient itching. Pain and swelling were further divided into mild to moderate (1 point) and severe (2 points). Theoretically, the score was in the range of 0–9. Calculated scores ranged 0–4. The patients were further divided into two groups with scores of 0–1 denoting minimal morbidity (MIN) and 2–4 denoting significant morbidity (SIG). The number of lesions in each morbidity-score group were comparable (MIN 17and SIG 15). There were no statistically significant differences between the groups regarding age, number of applications, or average injection volume per mm lesion. Statistically significant differences were noted regarding gender (p = 0.05), lesion diameter (p = 0.030), total volume of first (p = 0.007) and second application (p = 0.05), and total injected volume (p = 0.03). Factors contributing to the risk for significant morbidity included being male, lesion diameter > 5 mm, volume > 0.3 mL per application, and total injected volume > 0.3 mL. A waiting time of 12 weeks prior to additional EAO application was required in 12 out of 29 lesions for clinical observation of complete regression. It was concluded that sclerotherapy with EAO as monotherapy is easy to apply, safe, and effective within a small number of sessions. Application of <0.3 mL EAO per session, and a waiting time of 12 weeks prior to the second application, would significantly minimize morbidity.
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Affiliation(s)
- Itai Zeevi
- Department of Oral and Maxillofacial Surgery, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (I.Z.); (M.A.)
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tel Aviv University, Tel-Aviv 69978, Israel;
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqwa 49100, Israel
| | - Michael Alterman
- Department of Oral and Maxillofacial Surgery, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (I.Z.); (M.A.)
| | - Liat Chaushu
- Department of Periodontology and Implant Dentistry, School of Dental Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
- Correspondence:
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Song D, Guo L, Sheng H, Li J, Wang L, Wu C, Wang C, Niu Y, Zeng Q. DSA-guided percutaneous sclerotherapy for children with oropharyngeal low-flow venous malformation. Exp Ther Med 2020; 19:3405-3410. [PMID: 32266040 DOI: 10.3892/etm.2020.8581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022] Open
Abstract
The present study investigated the efficacy and safety of digital subtraction angiography-guided 3% polidocanol foam sclerosing agent, as well as the combination of pingyangmycin and dexamethasone, for the treatment of children with oropharyngeal low-flow venous malformation. A total of 27 children with 35 lesions with oropharyngeal low-flow venous malformation were included. The subjects were randomly divided into Groups A (13 patients with 16 lesions, treated with 3% polidocanol foam sclerosing agent) and B (14 patients with 19 lesions, treated with pingyangmycin + dexamethasone), respectively. The clinical efficacies and adverse reactions were analyzed and compared between these two groups. The average number of treatment times for Group A was 2.45±0.6, with an efficacy rate of 87.50%, while the average number of treatment times for Group B was 2.07±0.4, with an efficacy rate of 84.21%. No significant difference was found in the average treatment times or efficacy rates between Groups A and B. In addition, the adverse reaction incidence for Groups A and B were 38.46 and 14.29%, respectively, with statistically significant differences between these two groups. The combination of pingyangmycin and dexamethasone was safe and effective in treating children with oropharyngeal low-flow venous malformation, with fewer adverse reactions and is worthy of clinical promotion.
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Affiliation(s)
- Dan Song
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Hui Sheng
- Department of Radiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, P.R. China
| | - Jing Li
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Liang Wang
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Changhua Wu
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Changfeng Wang
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Yanli Niu
- Department of Vascular Anomalies and Interventional Radiology, Jinan, Shandong 250022, P.R. China
| | - Qingshi Zeng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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De Maria L, De Sanctis P, Balakrishnan K, Tollefson M, Brinjikji W. Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis. Neurointervention 2020; 15:4-17. [PMID: 31940716 PMCID: PMC7105094 DOI: 10.5469/neuroint.2019.00213] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/23/2019] [Indexed: 01/23/2023] Open
Abstract
We performed a systematic review and meta-analysis of studies performing sclerotherapy for treatment of venous malformations (VMs) of the face, head and neck. It is our hope that data from this study could be used to better inform providers and patients regarding the benefits and risks of percutaneous sclerotherapy for treatment of face, head and neck VMs. We searched PubMed, MEDLINE, and EMBASE from 2000–2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of neck, face and head VMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the VM. Data were analyzed using random-effects meta-analysis. Thirty-seven studies reporting on 2,067 patients were included. The overall rate of complete cure following percutaneous sclerotherapy with any agent was 64.7% (95% confidence interval [CI], 57.4–72.0%). Sodium tetradecyl sulfate had the lowest complete cure rate at 55.5% (95% CI, 36.1–74.9%) while pingyangmycin had the highest cure rate at 82.9% (95% CI, 71.1–94.7%). Overall patient satisfaction rates were 91.0% (95% CI, 86.1–95.9%). Overall quality of life improvement was 78.9% (95% CI, 67.0–90.8%). Overall permanent morbidity/mortality was 0.8% (95% CI, 0.3–1.3%) with no cases of mortality. Our systematic review and meta-analysis of 37 studies and over 2,000 patients found that percutaneous sclerotherapy is a very safe and effective treatment modality for treatment of VMs of the head, neck and face.
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Affiliation(s)
- Lucio De Maria
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Megha Tollefson
- Department of Dermatology and Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology and Vascular Centers, Mayo Clinic, Rochester, MN, USA
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Manzano BR, Premoli AM, Santaella NG, Ikuta CRS, Rubira CMF, Santos PSDS. Sclerotherapy as an esthetic indication in oral vascular malformations: a case series. An Bras Dermatol 2019; 94:521-526. [PMID: 31777351 PMCID: PMC6857549 DOI: 10.1016/j.abd.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 06/26/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The use of monoethanolamine oleate 5% is effective for the treatment of vascular malformations with low blood flow. OBJECTIVES To report a case series of vascular malformations in the mouth and oral cavity treated with monoethanolamine oleate 5%. METHODS A retrospective descriptive study was performed in electronic patient charts covering seven years. Patient demographics, diagnostic resources, lesion site, size, and number of applications of monoethanolamine oleate 5% were collected. RESULTS A total of 21 vascular malformations were recorded, located mostly on the lower lip (52.3%) and resolved in a single application in 14 patients. The authors found 19 patients treated with sclerotherapy. Thirteen were women and six were men, with a mean age of 61 years. STUDY LIMITATION Small sample size. CONCLUSIONS Sclerotherapy is an effective treatment for vascular malformations of the lips and oral cavity, with resolution after only one or two applications (n=16).
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Affiliation(s)
- Brena Rodrigues Manzano
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil.
| | - Aloizio Maciel Premoli
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Natalia Garcia Santaella
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Carla Renata Sanomiya Ikuta
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Cássia Maria Fisher Rubira
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
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Abstract
Vascular malformations (VMs) are benign lesions of blood vessels originated from an error in vascular morphogenesis during the embryologic phase. Generally, when located in the head and neck region VMs occurs in lips, tongue, buccal mucosa, gums, or palate. The VMs are usually asymptomatic, varies in size and may cause facial asymmetries. Different therapeutic modalities are available to treat VMs, which include surgical excision, cautery, cryotherapy, laser therapy, and sclerosing agents. The authors report 2 patients with extensive VM in the tongue treated with intralesional injection of a low-dose solution of monoethanolamine oleate (MO) and lidocaine. The first patient was a 69-year-old male patient and the 2nd a 65-year-old woman. In both patients, it were performed weekly application of 1:1 MO (Ethamolin) with Lidocaine (lidocaine 3% 1:50,000) in the amount of 0.1 mL of the solution per cm3 of lesion, with a total of 12 applications for each patient at the end of the treatment, with good results and without complications. It is important to be alert in which situation sclerotherapy should be used and that small doses of the sclerotherapeutic agent is essential for the prevention of complications after the procedure. Therefore, these patients showed that the sclerotherapy with MO may be an effective and simple treatment for extensive oral benign vascular lesions. In both patients, there was a great improvement in the clinical aspect of the lesions and patient's satisfaction.
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Fujiki M, Ozaki M, Kurachi I, Iwashina Y, Takushima A. Risk Factors for Macroscopic Haemoglobinuria After Sclerotherapy Using Ethanolamine Oleate for Venous Malformations. Eur J Vasc Endovasc Surg 2019; 58:105-111. [PMID: 31133447 DOI: 10.1016/j.ejvs.2018.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/17/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Sclerotherapy is an essential component of the treatment for venous malformations, and ethanolamine oleate (EO) is known as a useful sclerosing agent. However, macroscopic haemoglobinuria (MH) and subsequent renal impairment are severe complications after sclerotherapy using EO. The present study aimed to clarify the MH risk factors for better peri-operative management of venous malformations. METHODS Data collected during 130 procedures involving 94 patients who were undergoing sclerotherapy using EO for venous malformation were retrospectively analysed. Pre-operative and operative variables, including sex, age, pre-operative body mass index, location, depth, type of lesion, size, number of procedures, type of drainage vein, ratio of sclerosant to air, and injected total dose of 5% EO per body weight (BW), were examined. Univariable analysis and multivariable logistic regression were performed to determine the possible risk factors for MH. RESULTS Following sclerotherapy, MH occurred in 27.7% of patients, but no patient developed post-operative renal impairment because of aggressive hydration and haptoglobin administration. On univariable analysis, diffuse lesion, lesion size ≥50 cm2, and total injected dose of 5% EO ≥ 0.18 mL/kg were found to be the MH risk factors. Multivariable logistic regression analysis identified a total injected dose of 5% EO ≥ 0.18 mL/kg as the significant independent factor contributing to MH risk. CONCLUSIONS Macroscopic haemoglobinuria is a reversible complication if immediate and appropriate interventions with aggressive hydration and haptoglobin administration are performed; therefore, it should be closely monitored following sclerotherapy, especially when using 5% EO ≥ 0.18 mL/kg.
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Affiliation(s)
- Masahide Fujiki
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
| | - Mine Ozaki
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Isao Kurachi
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuki Iwashina
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Akihiko Takushima
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
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