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Color fundus photos at six days (A) and twenty-five days post sclerotherapy (B). A) Fundus photos demonstrate indistinct optic nerve margins, arteriolar attenuation, diffuse patchy retinal whitening, retinal edema, and a cherry red spot (OS) vs. normal fundus (OD) at six days post sclerotherapy. B) Fundus photos demonstrate disc pallor, peripapillary atrophy, marked attenuation and obliteration of arterioles, residual macular edema, tessellated fundus appearance, and inferior coarse hyper pigmentation (OS) vs. normal fundus (OD) at twenty-five days post sclerotherapy. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Source publication
Purpose
To illustrate a case of ocular infarction following percutaneous ethanol sclerotherapy of an orbital arteriovenous malformation.
Observations
The patient is a 31-year-old female who developed ocular infarction of the left eye with light perception vision, proptosis, ophthalmoplegia, and a cherry red spot following sclerotherapy of an orbit...
Contexts in source publication
Context 1
... day 6 after AVM repair, the patient was seen in clinic for further evaluation. Left eye clinical exam was unchanged except for a mild decrease in orbital swelling. Fundus photos demonstrated an indistinct optic disc, arteriolar attenuation and segmental filling, diffuse patchy retinal whitening, retinal edema, and a cherry red spot (Fig. 1A). Optical coherence tomography (OCT) macula revealed diffuse retinal thickening with intraretinal cystic spaces (Fig. 3A). Early phase fluorescein angiography (FA) revealed poor retinal vascular filling with a leading arterial edge of dye ( Fig. 2A), while indocyanine green angiography (ICGA) showed decreased choroidal perfusion ( Fig. ...
Context 2
... edge of dye ( Fig. 2A), while indocyanine green angiography (ICGA) showed decreased choroidal perfusion ( Fig. 2A). Late phase FA revealed vasculitis and leakage of dye (Fig. 2B). Repeat evaluation 20 days later was remarkable for hand motion vision, improved extraocular motility, decreased retinal thickening and areas of peripapillary atrophy (Fig. 1B). OCT macula revealed decreased retinal thickening consistent with retinal atrophy, and areas of choroidal thinning (from 242 μm thickness on post injection day 6, to 81 μm thickness at post injection day 25) corresponding to the areas of decreased perfusion observed on ICGA (Fig. ...
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Purpose:
We evaluated a choroidal macrovessel using optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA).
Observations:
A 79-year-old female presented with blurred vision in both eyes and metamorphopsia of the left eye. Mild cataract was noted in both eyes. Color fundus photography of the left eye revealed a r...
Citations
... The side effects and complications arising from the use of sclerosants and embolization agents has been well-reported [51][52][53][54][55][56]. Forty-three of the 56 articles included a description of the complications arising during or after the procedures. ...
Objectives
The primary aim of this study was to conduct a meta-analysis of the literature on interventional treatment for patients with extracranial AVM of the head and neck to identify a superior treatment. The secondary aim was to evaluate the methodological quality of associated articles published between 2000-2020.Methods
The literature search was conducted on PubMed, Embase, the Cochrane Library, and scholar.google.com. Studies, meeting the acceptable reference standard underwent meta-analysis. All identified literature underwent methodological quality analysis.ResultsOf 1560 screened articles, 56 were included in the literature review. Appropriate diagnostic tests were reported in 98% of included articles. 13% of included articles did not specify the embolization agent. Outcome analysis varied throughout. 45% of the authors used radiographic imaging for follow-up. 77% specified the span of follow-up of their entire patient collective. Two articles met the inclusion criteria for meta-analysis. Curing rate of transarterial ethanol embolization for intraosseous AVM was 83% with a complication rate of 58%. Curing rate of ethanol combined with NBCA or Onyx in soft tissue AVM was 18% with a complication rate of 87%.Conclusion
Our literature review revealed an absence of treatment or reporting standards for extracranial AVM of the head and neck. The meta-analysis is comprised of two articles and methodological quality is heterogeneous. We recommend implementing consistent reporting standards to facilitate comparability of studies and to provide robust data for the development of an evidence-based treatment strategy.Advances in knowledgeMeta-analysis showed a favorable radiological outcome for intraosseous AVM when treated with intraarterial ethanol embolization. Our analysis demonstrated that the published data on extracranial AVMs of the head and neck is lacking in consistency and quality, prompting agreement for the need of standardized reporting on AVM treatments.
... Currently, a widely implemented agent is polidocanol in a 0.25-4% concentration. The basis of action is irreversible damage to the endothelium and tunica media, in which the thrombus is deposited, leading to gradual fibrosis and vessel obliteration 12,[19][20][21][22] . ...
... A hybrid method combining EVLA and UGFS (echosclerotherapy) has largely replaced traditional surgery in treating primary varicose veins, recurrent varicose veins, and varicose lesions with active venous legs ulceration 21,31 . Echosclerotherapy is a minimally invasive, effective, and safe method for treating varicose veins 32 . ...
Objective:
Surgical treatment of chronic venous insufficiency (CVI) includes sclerotherapy, cryosurgery, CHIVA method (from the French for ambulatory conservative hemodynamic treatment venous insufficiency), chemical and mechanical obliteration, or phlebectomy. A hybrid treatment that combines sclerotherapy with endovenous laser ablation (EVLA) at 980 nm or 1470 nm or Nd:YAG laser at 1064 nm is also increasingly used. This paper synthesizes the current knowledge of CVI of the lower limbs and demonstrates promising clinical practice experiences using a hybrid method that combines EVLA with intraoperative or postoperative ultrasound-guided foam sclerotherapy (UGFS), also known as echosclerotherapy.
Patients and methods:
A group of 200 patients was enrolled in the study. All patients underwent a hybrid method of treatment combining EVLA and UGFS. Under tumescent anesthesia, venipuncture of the great saphenous vein (GSV) trunk was performed, followed by 1470 nm laser therapy (80-100J/10W). During the procedure, 2% polidocanol foam was injected into the insufficient collateral veins extending from the main trunk of the GSV. After surgery, compression therapy in the form of grade II compression stockings was used. All patients underwent a follow-up duplex Doppler ultrasound four weeks after the procedure.
Results:
It was observed that 196 patients had complete obstruction of the femoral segment of the GSV, while four patients showed signs of minor recanalization of the femoral segment. After 12 months, 198 patients showed complete fibrosis, partial or complete absorption of the saphenous vein, and varicose lesions. Two patients underwent UGFS again after 12 months because of recurrent varicose lesions. At four weeks after UGFS, local pain of thrombosed varicose lesions was observed in 20% of patients. Hemosiderin staining was observed in 15% of patients, but this completely resolved within 6-12 months. In 1% of cases, symptoms of dyspnea and cough were reported, which resolved a few minutes after the procedure - approximately 1% of patients presented with symptoms of matting. There were no severe complications during the 12-month follow-up period.
Conclusions:
A high efficiency of 98% was observed (196/200 patients) at the 12-month follow-up after hybrid EVLA with UGFS treatment. Follow-up UGFS at four weeks after laser ablation showed 99% efficacy at the 12-month postoperative follow-up. Major complications after the hybrid method treatment combining EVLA with UGFS were not observed. Hybrid methods are more effective (98-99%) and give a lower chance of relapse.
... Previous studies reported that treatment of AVMs fed by OphA is clinically challenging due to complex hypervascularity of AVMs and the risk of vision loss from OphA involvement 1, 4, 21 . Endovascular treatment is effective for AVMs 5,8,24 , and ethanol embolotherapy of periorbital and orbital AVMs improves symptoms to some extent 14,15,25 , and yet the overall results are not satisfactory. However, due to its close proximity to retinal central artery, which regulates visual acuity and extraocular movements, therapeutic approaches that are speci c for treatment of AVMs fed by OphA are scarce. ...
Background and purpose
Arteriovenous malformations (AVMs) derived ophthalmic artery (OphA) branches are not common, however, their management is very challenging. We aimed at evaluating the safety and efficacy of Trans OphA ethanol embolotherapy for these lesions.
Materials and methods
We retrospectively reviewed 26 patients with AVMs fed by OphA, who underwent transOphA embolization using ethanol from February, 2015 to December, 2019. Sixty-six transOphA embolotherapy procedures (range, 1-4 procedures; mean, 2.5 procedures) were performed. Degree of devascularization, visual field, visual acuity, and quality-of-life outcomes were compared and analyzed at follow ups (mean, 32.6 months; month range 10-60). Complications were recorded.
Results
Twenty of the 26 patients (77%) reported complete or >90% AVM devascularization while six patients (23%) showed >70% devascularization. Eleven patients (42%) presented with visual acuity impairments with 4 complete relief, 6 improvements. Eight patients (42%) presented visual field defects with 4 complete relief, 3 with improvements. Ten patients (38.4%) presented with diplopia and exophthalmos with 2 complete relief, 6 major improvements. Bleeding was controlled in all cases (100%). All patients (100%) exhibited cosmetic deformities with 17 being completely relieved. Moreover, all patients (100%) exhibited impaired daily life, which was resolved in 21 patients with 5 patients reporting major improvements. No vision loss, death, or permanent disability in all patients.
Conclusions
TransOphA ethanol embolotherapy was found to be efficacious, safe and it achieved symptomatic resolution or improvement of AVMs fed by OphA with acceptable complications without the risk of visual impairment.
Orbital arteriovenous malformations (AVM) are identified by abnormal high-flow connections between the veins and the arteries, which are often supplied by the branches of internal and external carotid arteries, also with a nidus of cellular stroma distributed between the vessels. Orbital arteriovenous malformations are rare among all congenital malformations. Pain, glaucoma, optic nerve ischemia and compression and retinal ischemia are some of the causes of enlarging orbital AVMs. Because of the rare nature of these lesions, they are usually misdiagnosed and treated improperly. For the diagnosis of such orbital AVMs, angiography becomes an essential tool. The primary method of diagnosing orbital AV malformations are non-invasive cross-sectional imaging and catheter angiography. Treatment for the same includes reducing the blood flow to the arteriovenous malformation (AVM) via preoperative embolization. And surgical resection. Complete excision is challenging because of the increased risk of involvement of the ophthalmic artery which can cause vision loss, preoperative embolization is difficult in some patients. An effective way of treating arteriovenous malformation is ethanol sclerotherapy. Diagnosing and managing Orbital AV malformations is important as these are rare and can cause permanent vision loss.
Arteriovenous malformation (AVM)-derived ophthalmic artery (OphA) branches are not common, and their management is very challenging. We evaluated the safety and efficacy of Trans OphA ethanol embolotherapy for these lesions. We retrospectively reviewed 26 patients with AVMs fed by OphA, who underwent transOphA embolization using ethanol from February, 2015 to December, 2019. Sixty-six transOphA embolotherapy procedures (range, 1–4 procedures; mean, 2.5 procedures) were performed. Devascularization degree, visual field, visual acuity, and quality-of-life outcomes were compared and analyzed at follow up (mean, 32.6 months; month range 10–60). Complications were recorded. Twenty-five of the 26 patients (96%) reported complete or > 90% AVM devascularization while one patient (4%) showed > 70% devascularization. Eleven patients (42%) presented with visual acuity impairments; among them, 6 had improvements while 4 were completely relieved. Eight patients (30.7%) presented visual field defects, 3 had improvements while 4 were completely relieved. Ten patients (38.4%) presented with diplopia and exophthalmos with 2 being completely relieved while 6 had major improvements. Bleeding was controlled in all cases (100%). All patients (100%) exhibited cosmetic deformities with 17 being completely relieved. Moreover, all patients (100%) exhibited impaired daily life, which was resolved in 21 patients with 5 patients reporting major improvements. After endovascular treatment, there was no vision loss, death, or permanent disability in any patient. TransOphA ethanol embolotherapy is efficacious and safe for symptomatic resolution or improvement of AVMs fed by OphA with acceptable complications without the risk of visual impairment.
