Pharmacology of Sclerotherapy

ABSTRACT

Sclerotherapy is the therapeutic use of sclerosants in the controlled destruction of undesired target tissues. Sclerosants have been used in vascular and nonvascular settings, both as primary and adjunctive therapy. Effective sclerotherapy requires a conceptual understanding of key questions about the process being treated, including the method of delivery, the presence of flow, and the required contact time to initiate sclerosis. However, beyond technique and delivery, practical and safe application of sclerotherapy requires an understanding of the uses, limitations, dosing, and side effects of sclerosants used during interventional radiology procedures. Agents discussed here include detergents and surfactants [ethanol, Sotradecol^® (Bioniche Pharma, Pointe Claire, Quebec and Angiodynamics, Latham, NY), ethanolamine oleate], hypertonics (saline, glucose), and a review of several other types that are used less frequently.

Sclerotherapy - ethanol - Sotradecol^® - hypertonic solutions - ethanolamine oleate - sclerosants

REFERENCES

• 1 Sasaki M, Tadokoro S, Kimura S, Mori M, Kosuda S, Tachibana M. Two cases of renal arteriovenous fistula treated by transcatheter embolization with absolute ethanol.  Hinyokika Kiyo. 1984;  30(3) 295-298
• 2 Yakes W F, Pevsner P, Reed M, Donohue H J, Ghaed N. Serial embolizations of an extremity arteriovenous malformation with alcohol via direct percutaneous puncture.  AJR Am J Roentgenol. 1986;  146(5) 1038-1040
• 3 Becker G H, Holden R W, Heun Y Y, Klatte E C. Ablation with absolute alcohol. In: Castaneda-Zuniga WR, Tadavarthy SM Interventional Radiology. Baltimore; Williams and Wilkins 1992: 135-152
• 4 Ellman B A, Green C E, Eigenbrodt E, Garriott J C, Curry T S. Renal infarction with absolute ethanol.  Invest Radiol. 1980;  15(4) 318-322
• 5 Do Y S, Yakes W F, Shin S W et al.. Ethanol embolization of arteriovenous malformations: interim results.  Radiology. 2005;  235(2) 674-682
• 6 Mourao G S, Hodes J E, Gobin Y P, Casasco A, Aymard A, Merland J J. Curative treatment of scalp arteriovenous fistulas by direct puncture and embolization with absolute alcohol. Report of three cases.  J Neurosurg. 1991;  75(4) 634-637
• 7 Hyodoh H, Hori M, Akiba H, Tamakawa M, Hyodoh K, Hareyama M. Peripheral vascular malformations: imaging, treatment approaches, and therapeutic issues.  Radiographics. 2005;  25(Suppl 1) S159-S171
• 8 Ellman B A, Parkhill B J, Marcus P B, Curry T S, Peters P C. Renal ablation with absolute ethanol. Mechanism of action.  Invest Radiol. 1984;  19(5) 416-423
• 9 Rabe F E, Yune H Y, Richmond B D, Klatte E C. Renal tumor infarction with absolute ethanol.  AJR Am. J Roentgenol. 1982;  139 343-345
• 10 Dubois J, Garel L, Gordon Culham J A. Pediatric interventional angiography. In: Baum S, Pentecost MJ Abrams' Angiography Interventional Radiology. 2^nd ed. Philadelphia; Lippincott Williams and Wilkins 2006: 1047-1068
• 11 Katz J M, Gobin Y P, Riina H A. Techniques and devices in interventional neuroradiology. In: Hurst RW, Rosenwasser RH Interventional Neuroradiology. New York; Informa 2008: 161-182
• 12 American Society of Gastroenterology . Technology Status Evaluation Report: Sclerosing agents for use in GI endoscopy.  Gastrointest Endosc. 2007;  66(1) 1-6
• 13 Moller J E, Helweg-Larsen J, Jacobsen E. Histopathological lesions in the sciatic nerve of the rat following perineural application of phenol and alcohol solutions.  Dan Med Bull. 1969;  16(4) 116-119
• 14 Rumsby M G, Finean J B. The action of organic solvents on the myelin sheath of peripheral nerve tissue. 3. Chlorinated hydrocarbons.  J Neurochem. 1966;  13(12) 1513-1515
• 15 Politis M J, Schaumburg H H, Spencer P S. Neurotoxicity of selected chemicals. In: Spencer PS, Schaumburg HH Experimental and chemical neurotoxicity. Baltimore; Williams and Wilkins 1980: 613-630
• 16 Simonetti G, Profili S, Sergiacomi G L, Meloni G B, Orlacchio A. Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy.  Cardiovasc Intervent Radiol. 1993;  16(2) 81-84
• 17 Darcy M. Renal cysts and urinomas. In: Baum S, Pentecost MJ Abrams' Angiography Interventional Radiology. 2^nd ed. Philadelphia; Lippincott Williams and Wilkins 2006: 764-776
• 18 Yakes W S, Parker S H. Diagnosis and management of vascular anomalies. In: Castaneda-Zuniga WR, Tadavarthy SM Interventional Radiology. Baltimore; Williams and Wilkins 1992: 152-189
• 19 Phan P, Burton A W. Interventional pain procedures for cancer pain. In: Baum S, Pentecost MJ Abrams' Angiography Interventional Radiology. 2^nd ed. Philadelphia; Lippincott Williams and Wilkins 2006: 31-55
• 20 Mason K P, Neufeld E J, Karian V E, Zurakowski D, Koka B V, Burrows P E. Coagulation abnormalities in pediatric and adult patients after sclerotherapy or embolization of vascular anomalies.  AJR Am J Roentgenol. 2001;  177(6) 1359-1363
• 21 Dietzek C L. Sclerotherapy: introduction to solutions and techniques.  Perspect Vasc Surg Endovasc Ther. 2007;  19(3) 317-324
• 22 Ramírez-Amador V, Esquivel-Pedraza L, Lozada-Nur F et al.. Intralesional vinblastine vs. 3% sodium tetradecyl sulfate for the treatment of oral Kaposi's sarcoma. A double blind, randomized clinical trial.  Oral Oncol. 2002;  38(5) 460-467
• 23 Ajekigbe L, Stothard J. The effectiveness of sodium tetradecyl sodium in the treatment of wrist ganglia.  Can J Plast Surg. 2006 Spring;  14(1) 28-30
• 24 Cho K J, Brady T M, Anver M R. Renal artery occlusion and infarction with Sotradecol.  Invest Radiol. 1983;  18(1) 68-73
• 25 Becker G J, Kopecky K K. Can the newer interventional procedures replace cholecystectomy for cholecystolithiasis? The potential role of percutaneous cystic duct ablation.  Radiology. 1988;  167(1) 275-279
• 26 Kinnison M L, Kadir S, Strandberg J D, Anderson J H, White Jr R I. Percutaneous spermatic vein occlusion: evaluation of sclerosing agents in experimental animals.  Radiology. 1986;  161(2) 299-301
• 27 Girard M J, Saini S, Mueller P R et al.. Percutaneous chemical gallbladder sclerosis after laser-induced cystic duct obliteration: results in an experimental model.  AJR Am J Roentgenol. 1992;  159(5) 997-999
• 28 Becker C D, Quenville N F, Burhenne H J. Gallbladder ablation through radiologic intervention: an experimental alternative to cholecystectomy.  Radiology. 1989;  171(1) 235-240
• 29 Gomes A S. Embolization therapy of congenital arteriovenous malformations: use of alternate approaches.  Radiology. 1994;  190(1) 191-198
• 30 O'Donovan J C, Donaldson J S, Morello F P, Pensler J M, Vogelzang R L, Bauer B. Symptomatic hemangiomas and venous malformations in infants, children, and young adults: treatment with percutaneous injection of sodium tetradecyl sulfate.  AJR Am J Roentgenol. 1997;  169(3) 723-729
• 31 Gandini R, Konda D, Reale C A et al.. Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate—outcome in 244 patients.  Radiology. 2008;  246(2) 612-618
• 32 Gandini R, Chiocchi M, Konda D, Pampana E, Fabiano S, Simonetti G. Transcatheter foam sclerotherapy of symptomatic female varicocele with sodium-tetradecyl-sulfate foam.  Cardiovasc Intervent Radiol. 2008;  31(4) 778-784 , Such
• 33 Tan K T, Kirby J, Rajan D K, Hayeems E, Beecroft J R, Simons M E. Percutaneous sodium tetradecyl sulfate sclerotherapy for peripheral venous vascular malformations: a single-center experience.  J Vasc Interv Radiol. 2007;  18(3) 343-351
• 34 Pereiras R, Viamonte Jr M, Russell E, LePage J, White P, Hutson D. New techniques for interruption of gastroesophageal venous blood flow.  Radiology. 1977;  124(2) 313-323
• 35 Ellman B A, Curry III T S, Glotzbach R E, Simpson P R. Systemic embolization as a complication of transhepatic venography.  Radiology. 1981;  141(1) 67-71
• 36 Feldman L, Greenfield A J, Waltman A C et al.. Transcatheter vessel occlusion: angiographic results versus clinical success.  Radiology. 1983;  147(1) 1-5
• 37 Becker C D, Fache J S, Malone D E, Stoller J L, Burhenne H J. Ablation of the cystic duct and gallbladder: clinical observations.  Radiology. 1990;  176(3) 687-690
• 38 Becker G J, Kopecky K K. Can the newer interventional procedures replace cholecystectomy for cholecystolithiasis? The potential role of percutaneous cystic duct ablation.  Radiology. 1988;  167(1) 275-279
• 39 Girard M J, Saini S, Mueller P R et al.. Percutaneous chemical gallbladder sclerosis after laser-induced cystic duct obliteration: results in an experimental model.  AJR Am J Roentgenol. 1992;  159(5) 997-999
• 40 Martin E C, Getrajdman G I. Does the gallbladder have a future?.  Radiology. 1989;  170(3 Pt 2) 969-973
• 41 Bergan J, Pascarella L, Mekenas L. Venous disorders: treatment with sclerosant foam.  J Cardiovasc Surg (Torino). 2006;  47(1) 9-18
• 42 Tisi P V, Beverley C, Rees A. Injection sclerotherapy for varicose veins. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD001732. DOI:10.1002/14651858. CD001732.pub2
• 43 Coleridge Smith P. Saphenous ablation: sclerosant or sclerofoam?.  Semin Vasc Surg. 2005;  18(1) 19-24
• 44 Pope A J, Ormiston M C, Bogod D G. Sclerotherapy in the treatment of recurrent lymphocele.  Postgrad Med J. 1982;  58(683) 573-574
• 45 Mason K P, Neufeld E J, Karian V E, Zurakowski D, Koka B V, Burrows P E. Coagulation abnormalities in pediatric and adult patients after sclerotherapy or embolization of vascular anomalies.  AJR Am J Roentgenol. 2001;  177(6) 1359-1363
• 46 QOL Medical. Corporate Web site. http://Available at: www.ethamolin.net Accessed January 10, 2010
• 47 Masaki M, Obara K, Suzuki S et al.. The destructive effects of sclerosant ethanolamine oleate on mammalian vessel endothelium.  Gastroenterol Jpn. 1990;  25(2) 230-235
• 48 Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices: Part 2. Strategy and techniques based on hemodynamic features.  Radiographics. 2003;  23(4) 921-937 discussion 937
• 49 Coldwell D M. Invited Commentary.  Radiographics. 2003;  23 937
• 50 Beppu T, Iwatsuki M, Okabe H et al.. A new approach to percutaneous transhepatic portal embolization using ethanolamine oleate iopamidol.  J Gastroenterol. 2010;  45(2) 211-217
• 51 Kaji N, Kurita M, Ozaki M et al.. Experience of sclerotherapy and embolosclerotherapy using ethanolamine oleate for vascular malformations of the head and neck.  Scand J Plast Reconstr Surg Hand Surg. 2009;  43(3) 126-136
• 52 Hyodoh H, Akiba H, Hyodoh K, Ezoe K, Yotsuyanagi T, Hareyama M. Effects of blood flow control on clinical outcomes after ethanolamine oleate sclerotherapy for vascular malformations.  Jpn J Radiol. 2009;  27(8) 297-302
• 53 Hyodoh H, Hori M, Akiba H, Tamakawa M, Hyodoh K, Hareyama M. Peripheral vascular malformations: imaging, treatment approaches, and therapeutic issues.  Radiographics. 2005;  25(Suppl 1) S159-S171
• 54 Kayama H, Inamori M, Togawa J et al.. Pleural effusions following endoscopic injection sclerotherapy for cirrhotic patients with esophageal varices.  Hepatogastroenterology. 2006;  53(69) 376-380
• 55 Kilicoglu B, Kismet K, Kilicoglu S S et al.. Effects of honey as a scolicidal agent on the hepatobiliary system.  World J Gastroenterol. 2008;  14(13) 2085-2088
• 56 Goldman M P. A comparison of sclerosing agents. Clinical and histologic effects of intravascular sodium morrhuate, ethanolamine oleate, hypertonic saline (11.7%), and sclerodex in the dorsal rabbit ear vein.  J Dermatol Surg Oncol. 1991;  17(4) 354-362
• 57 Lu Y Q, Huang W D, Cai X J, Gu L H, Mou H Z. Hypertonic saline resuscitation reduces apoptosis of intestinal mucosa in a rat model of hemorrhagic shock.  J Zhejiang Univ Sci B. 2008;  9(11) 879-884
• 58 Mactier R A. The spectrum of peritoneal fibrosing syndromes in peritoneal dialysis.  Adv Perit Dial. 2000;  16 223-228
• 59 Soria M, Arrieta J, Ugarte I, Moina I, Guerra M, Escanero J. [Intracellular pH changes induced by sclerosing agents in peritoneal fibroblasts].  Nefrologia. 2004;  24(2) 158-166
• 60 van Westrhenen R, Vlijm A, Hiralall J K, Krediet R T. Experimental study on long-term exposure to a biocompatible, hypertonic, pyruvate-buffered dialysis solution.  Perit Dial Int. 2008;  28(Suppl 5) S43-S47
• 61 Akhan O, Gumus B, Akinci D, Karcaaltincaba M, Ozmen M. Diagnosis and percutaneous treatment of soft-tissue hydatid cysts.  Cardiovasc Intervent Radiol. 2007;  30(3) 419-425
• 62 Min T. Interventional radiology of venous insufficiency. In: Baum S, Pentecost MJ Abrams' Angiography Interventional Radiology. 2^nd ed. Philadelphia; Lippincott Williams and Wilkins 2006: 1099-1109
• 63 Sadick N S. Hyperosmolar versus detergent sclerosing agents in sclerotherapy. Effect on distal vessel obliteration.  J Dermatol Surg Oncol. 1994;  20(5) 313-316
• 64 Aupetit J F, Ritz B, Ferrini M, Coppin M, Champsaur G. Images in cardiovascular medicine. Hydatid cyst of the interventricular septum.  Circulation. 1997;  95(9) 2325-2326
• 65 Salomon J L, Bourgeois A, Le Baleur A, Pillot P, Gillot C, Frileux C. [Product of choice for maintenance sclerosis: 66% glucose solution].  Phlebologie. 1983;  36(3) 249-254
• 66 Consolo P, Luigiano C, Giacobbe G, Scaffidi M G, Pellicano R, Familiari L. Cyanoacrylate glue in the management of gastric varices.  Minerva Med. 2009;  100(1) 115-121
• 67 Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices. Part 1. Anatomic classification.  Radiographics. 2003;  23(4) 911-920
• 68 Baysal T, Soylu A. Percutaneous treatment of simple renal cysts with n-butyl cyanoacrylate and iodized oil.  Diagn Interv Radiol. 2009;  15(2) 148-152
• 69 Kim S H, Moon M W, Lee H J, Sim J S, Kim S H, Ahn C. Renal cyst ablation with n-butyl cyanoacrylate and iodized oil in symptomatic patients with autosomal dominant polycystic kidney disease: preliminary report.  Radiology. 2003;  226(2) 573-576
• 70 Cragg A H, Galliani C A, Rysavy J A, Castaneda-Zuniga W R, Amplatz K. Endovascular diathermic vessel occlusion.  Radiology. 1982;  144(2) 303-308
• 71 Herrera M A, Di Segni R, Kaye K W et al.. Embolization of the internal spermatic vein with mechanical devices for the treatment of varicocele. In Castaneda-Zuniga WR, Tadavarthy SM Interventional Radiology. Baltimore; Williams and Wilkins 1992: 100-110
• 72 VenBrux AC .Pelvic venous incompetence: pelvic congestion syndrome. In: Baum S, Pentecost MJ Abrams' Angiography Interventional Radiology. 2^nd ed. Philadelphia; Lippincott Williams and Wilkins 2006: 830-836
• 73 Wible B C, Mitchell S. Doxycycline sclerotherapy of an intraosseous femoral lymphatic malformation: case report and literature review.  J Vasc Interv Radiol. 2009;  20(5) 660-663