Aarthi, B K (2011) Effect of foam Sclerotherapy in various Vascular and Lymphatic Malformations. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION : Sclerotherapy is an intravascular injection of a chemical irritant to cause chemical thrombophlebitis. The term was coined in the 1940's by American physician H. I. Biegeleisen[1]. Sclerotherapy is being used in treating varicose veins, hemangiomas and lymphangiomas. Introduced more than 150 years ago[2], sclerotherapy remains the most effective procedure for permanent eradication of pathologically enlarged as well as cosmetically undesirable but otherwise normal veins. Innovative devices have been introduced within the past 10 years that utilize electromagnetic energy sources to target vein wall constituents directly or indirectly and either transcutaneously or intravascularly, but these procedures are significantly less effective and reproducible than sclerotherapy for permanently eradicating unwanted veins. Foam sclerotherapy, in which the sclerosant is mixed with air or physiological gases, is more efficacious than direct injection of sclerosants[3], as air in the foam prolongs the contact of the agent with the endothelium. Hence, maximum sclerosant action can be obtained at lesser concentration and quantity. Foamed agent exerts its effect at microcirculation, which is inaccessible to other procedures. AIM OF THE STUDY : 1. To assess the effectiveness of foam sclerotherapy in various vascular and lymphatic malformations. 2. To observe the adverse effects of foam sclerotherapy during and after the procedure. MATERIALS AND METHODS : Study type : Prospective non-randomized interventional study Study population : 40 patients of both sex; age group : 15 to 65 years. {28 with varicose veins with complications, 10 with hemangioma, 2 with lymphangioma} Study period : January 2009 to September 2010 (18 months). First 6 months : Interventional period. Next 12 months : follow-up period. Place of study : Department of Dermatology, Govt. Stanley Medical College, Chennai. The patients chosen for the study, were from the general pool attending the Dermatology out patient department. Initially, 70 patients with varicose veins who came with complaints of pain, itching, edema, discolouration, dilated veins over legs; 15 with hemangioma presenting with swelling and 2 with lymphangioma were subjected to the pre-sclerotherapy consultation, assessment and investigations as given below. Out of them, 28 patients with varicose veins (legs), 10 patients with hemangioma (tongue, gluteal region, hand, trunk of size varying from a minimum of 3 x 2cm to a maximum of 12x8cm) and 2 with lymphangioma (posterior one third of tongue and gluteal region), who were enrolled for the study, according to the inclusion and exclusion criteria. The mean age group was 32.7 years (15 – 65 years) of both sexes. RESULTS : Total no. of patients in the study group : Male : 30, Female : 10. Out of 28 patients with varicose veins –3 patients presented with pain over the dilated veins, 3 with swelling of feet, 2 with itching, 4 with discolouration of legs, 4 with leg ulcer, 12 with stasis dermatitis. CONCLUSION : Following were the conclusions derived from this study • Sclerotherapy is a potentially valuable method of treatment for vascular and lymphatic malformations • Foam sclerotherapy causes maximal sclerosant action at lesser concentration and quantity • The effect is exerted at microcirculation which cannot be achieved through any other procedures. • This study demonstrates a complete resolution rate of 89.2% for varicose veins in an average of 4.2 sittings, 70% for hemangiomas – average of 3.9 sittings and 50% in case of lymphangiomas in 5.5 sittings (average), over a period of 18 months. • The healing of stasis dermatitis (66.7%) and venous ulcers (50%) were found to be accelerated following foam sclerotherapy. • Though a recurrence rate of 10.7% was noted in patients with varicose veins, foam sclerotherapy is a minimally invasive technique that can be repeated without any real increase in the risks or complexity of the procedure. • Only minor adverse effects like postsclerotherapy pigmentation , cutaneous devitalisation (1 patient) were noted. No major complications like anaphylaxis, pulmonary embolism or stroke were observed. • Hence foam sclerotherapy is a simple, safer, feasible, affordable in-office procedure which can be performed without hospitalization or anaesthesia. • It allows the patient, a rapid return to normal daily activity • Furthermore it is cheap in comparison to almost all of the other methods available today.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | foam Sclerotherapy ; Vascular ; Lymphatic Malformations. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Mar 2018 02:46 |
| Last Modified: | 03 Mar 2018 01:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5962 |
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