Ethanol threshold doses for systemic complications during sclerotherapy of superficial venous malformations: a retrospective study.
BACKGROUND
Ethanol has been used for many years for superficial venous malformations (VM) sclerotherapy. Although ethanol is well-tolerated in most of the cases, systemic side effects have been reported in some patients, including cardiac collapse and death. Systemic toxic side effects have been suspected to be proportional to the ratio of ethanol dose divided by the patient's body weight (dose/weight ratio in millilitre per kilogram). No extensive study has yet been conducted to determine the toxic threshold, and no consensus exists on this point.


METHODS
We retrospectively studied the systemic effects of ethanol sclerotherapy in a consecutive series of 71 patients with VM.


RESULTS
Seventy-one consecutive patients with VMs were treated by ethanol sclerotherapy and 162 procedures were performed. The only factor significantly associated with a systemic adverse event was the ethanol dose/weight ratio per intervention. The ethanol dose/weight ratio superior to 0.24 ml/kg was predictive of systemic toxic effects, suggesting a limit dose for ethanol sclerotherapy of VM. Systematic complications were not related to repetitive sclerotherapy sessions.


CONCLUSIONS
Based on our findings, a maximal ethanol dose/weight ratio of 0.2 ml/kg could be considered as acceptable in VM treatment indications.
Department of Neuroradiology, Lariboisière Hospital, 2, rue Ambroise Paré, 75010 Paris, France. annouk.bisdorff@lrb.aphp.fr
Annouk
A
Bisdorff
Mikael
M
Mazighi
Jean Pierre
JP
Saint-Maurice
René
R
Chapot
Anne-Claire
AC
Lukaszewicz
Emmanuel
E
Houdart
D000293:Adolescent; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000628:therapy*; D055815:Young Adult
D000891:Anti-Infective Agents, Local; D000431:Ethanol