Paraplegia after sclerotherapy of varicose leg veins

Summary

We would like to present the case of paraplegia due to venous spinal ischaemia, which occurred after sclerotherapy of leg veins and subsequent to previous venous surgery. After exclusion of other pathogenetic causes such as surgery, tumescent local anaesthesia or neurological, infections, cardiological and haemosteaseological causes, this complication must be regarded as a consequence of sclerotherapy. Sources in literature describe shunts (shortened connections) between the leg veins and the venous spinal system, thus enabling minutest particles from sclerotherapy to enter the veins and possibly have a cytotoxic or microembolic effect with spinal ischaemia.

Keywords

Paraplegia - venous spinal ischaemia - venous sclerotherapy - venous surgery - tumescent local anaesthesia

• References

• 1 Batson OV. The function of the vertebral veins and their role in the spread of metastases. Ann Surg 1940; 112: 138-149.
• 2 Böhler-Sommeregger K, Karnel F, Schuller-Petrovic S, Santler R. Do teleangiectasis communicate with the deep venous system?. The Journal of Dermatologic Surgery and Oncology 2007; 18: 403-406.
• 3 Buurman R, Bücheler E. The clinical significance of phlebography of the paravertebral veins. In: May R, Weber J. (Hrsg.) Pelvic and Abdominal Veins: Progress in Diagnostics and Therapy. Amsterdam, Oxford, Princeton: Excerpta medica; 1972
• 4 Clarke CE, Cumming WJK. Subacute myelopathy caused by spinal venous infarction. Postgraduate Medical Journal 1987; 63: 669-671.
• 5 Cooley-Andrade O, Goh WX, Connor DE, Ma DDF, Parsi K. Detergent sclerosants stimulate leukocyte apoptosis and oncosis. Eur J Vasc Endovasc Surg 2016; 51: 846-856.
• 6 Frings N, Glowacki P, Greiner A, Rass K. Off-label use der Tumeszenzlokalanästhesie bei endovenösen und operativen Verfahren. Phlebologie 2016; 45: 234-238.
• 7 Goldman MP. Treatment of Varicose and Telangiectatic Leg Veins. St Louis, Baltimore, Boston, Chicago, London, Philadelphia, Sydney, Toronto: Mosby Year Book; 1991: 185 256–257.
• 8 Goldman MP, Guex JJ, Weiss RA. Sclerotherapy – Treatment of Varicose and Telangiectatic Leg Veins – 5th Edition. Edinburgh, London, New York, Oxford, Philadelphia, St Louis, Sydney, Toronto: Elsevier Health Services; 2011: 3 209, 217–218.
• 9 Goor W, Leu HJ, Mahler F. Thrombosen in tiefen Venen und in Arterien nach Varizensklerosierung. VASA 1987; 16: 124 ff.
• 10 Griessenauer CJ, Raborn J, Foreman P, Shoja MM, Loukas M, Shane Tubbs R. Venous drainage of the spine and spinal cord: A comprehensive review of its history, embryology, anatomy, physiology and pathology. Clinical Anatomy 2015; 28: 75-87.
• 11 Hanisch F, Müller T, Krivokuca M, Winterholler M. Stroke following variceal sclerotherapy. Eur J Med Res 2004; 9: 282-284.
• 12 Heller SL, Meyer JR, Russell EJ. Spinal cord venous infarction following endoscopic sclerotherapy for esophageal varices. Neurology 1996; 47: 1081-1085.
• 13 Klein JA, Jeske DR. Estimated maximal safe dosages of tumescent lidocaine. Anest Analg 2015; 122: 1350-1359.
• 14 Kreussler Pharma. Fachinformation (Zusammenfassung der Produkteigenschaften) Aethoxysklerol® 0,25 % – 3 % August 2015; 3.
• 15 Kutta A, Moersdorf M. Zum Problem der Kollateralen zwischen Vena testicularis und spinalem venösen System bei der antegraden Varikozelensklerosierung. Aktuel Urol 1998; 29: 124-126.
• 16 Mastracci TM. Scientific methods and the reporting of negative results: Critically important to patient safety. Eur J Vasc Endovasc Surg 2016; 51: 165-166.
• 17 Mußbach F, Dahmen U, Dirsch O, Settmacher U. ,,Liver enginering“ als neue Quelle von Spenderorganen. Der Chirurg 2016; 87: 504-513.
• 18 Nesbitt C, Bedenis R, Bhattaarya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. The Cochrane Collaboration 2014
• 19 Passariello R, Farina E, Neuhardt DL. A severe neurological event during a local anaethesia phlebectomy. Phlebology 2011; 26: 40-43.
• 20 Rabe E, Gerlach H, Breu FX, Guggenbichler S, Stücker M, Pannier F. Sklerosierungsbehandlung der Varikose. Leitlinie der Deutschen Gesellschaft für Phlebologie. AWMF online, AWMF-Register Nr. 037/ 015; Stand 05/ 2015: 1-18.