Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.004418
Jornal Vascular Brasileiro
Case Report

Isquemia cerebral após escleroterapia com espuma guiada por ultrassom

Cerebrovascular ischemia following ultrasound-guided foam sclerotherapy

Agamenon Hülse Bittencourt, Daniela Vianna Dallanora, Nelson Rafael Bacega, Vinicius Saul Cembranel

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Resumo

A isquemia cerebral é uma complicação muito rara e perigosa da escleroterapia com espuma guiada por ultrassom no tratamento de varizes. Este caso descreve uma isquemia cerebral da área de Broca após escleroterapia com espuma guiada por ultrassom. Menos de uma hora após injeção de 10 mL de espuma, uma até então saudável mulher apresentou afasia, sem quaisquer outros sinais neurológicos. No caminho para casa, uma completa incapacidade de fala foi observada. Levada ao hospital mais próximo, foi diagnosticada com reação alérgica. Na manhã seguinte, compareceu ao consultório para relatar a reação alérgica, quando um correto diagnóstico foi feito. Ela ficou recuperada dois dias depois do procedimento, mas uma ressonância magnética mostrou sinais de isquemia recente da área de Broca e um ecocardiograma transesofágico mostrou um forame oval patente. Embora raros, devemos concentrar nossos esforços em prevenir tais eventos para que não precisem de tratamento.

Palavras-chave

varizes; escleroterapia; isquemia cerebral.

Abstract

Cerebral ischemia is a very rare and harmful complication of ultrasound-guided foam sclerotherapy for treatment of varicose veins. This case describes a documented cerebrovascular ischemia in Broca’s area following ultrasound-guided foam sclerotherapy. Less than one hour after intravenous injection of 10 ml of sclerosing foam, an otherwise healthy woman experienced aphasia without any other signs of neurological changes. When she arrived home, a complete inability to talk was observed. The event was misdiagnosed by another doctor as an allergic reaction. Next morning she came to the office to report the allergic reaction, where an appropriate diagnosis was made. She recovered just two days after the injection, but signs of recent cerebral ischemia were seen in Broca’s area on magnetic resonance and transesophageal bubble study echocardiogram revealed a patent foramen ovale. Although rare, we must make great effort to prevent these events instead of treating them.

Keywords

varicose veins; sclerotherapy; cerebral ischemia.

References

1. Cavezzi A, Parsi K. Complications of foam sclerotherapy. Phlebology. 2012;27(1 Suppl 1):46-51. http://dx.doi.org/10.1258/phleb.2012.012s09. PMid:22312067.

2. Sarvananthan T, Shepherd AC, Willenberg T, Davies AH. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg. 2012;55(1):243-51. http://dx.doi.org/10.1016/j.jvs.2011.05.093. PMid:21840152.

3. Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2013;0:1-17. PMid:23559590.

4. Rathbun S, Norris A, Morrison N, et al. Performance of endovenous sclerotherapy in the USA for the treatment of venous disorders: ACP/SVM/AVF/SIR quality improvement guidelines. Phlebology. 2014;29(2):76-82. http://dx.doi.org/10.1177/0268355512471920. PMid:23390217.

5. Hagen PT, Scholz D, Edwards W. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984;59(1):17-20. http://dx.doi.org/10.1016/S0025-6196(12)60336-X. PMid:6694427.

6. Cavezzi A, Tessari L. Foam sclerotherapy techniques: different gases and methods of preparation, catheter versus direct injection. Phlebology. 2009;24(6):247-51. http://dx.doi.org/10.1258/phleb.2009.009061. PMid:19952380.

7. Todd KL 3rd, Wright D, VANISH-2 Investigator Group. The VANISH-2 study: a randomized, blinded, multicenter study to evaluate the efficacy and safety of polidocanol endovenous microfoam 0.5% and 1.0% compared with placebo for the treatment of saphenofemoral junction incompetence. Phlebology. 2014;29(9):608-18. http://dx.doi.org/10.1177/0268355513497709. PMid:23864535.

8. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26(9):921-64. http://dx.doi.org/10.1016/j.echo.2013.07.009. PMid:23998692.

9. Side CD, Gosling RG. Non-surgical assessment of cardiac function. Nature. 1971;232(5309):335-6. http://dx.doi.org/10.1038/232335a0. PMid:5094838.

10. Reeves ST, Finley AC, Skubas NJ, et al. Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26(5):443-56. http://dx.doi.org/10.1016/j.echo.2013.02.015. PMid:23622926.

11. Daniel WG, Erbel R, Kasper W, et al. Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations. Circulation. 1991;83(3):817-21. http://dx.doi.org/10.1161/01. CIR.83.3.817. PMid:1999032.

12. Seward JB, Khandheria BK, Oh JK, Freeman WK, Tajik AJ. Critical appraisal of transesophageal echocardiography: limitations, pitfalls, and complications. J Am Soc Echocardiogr. 1992;5(3):288-305. http://dx.doi.org/10.1016/S0894-7317(14)80352-0. PMid:1622623.

13. Lennon MJ, Gibbs NM, Weightman WM, Leber J, Ee HC, Yusoff IF. Transesophageal echocardiography-related gastrointestinal complications in cardiac surgical patients. J Cardiothorac Vasc Anesth. 2005;19(2):141-5. http://dx.doi.org/10.1053/j.jvca.2005.01.020. PMid:15868517.

14. Kosehan D, Akin K, Koktener A, Cakir B, Aktas A, Teksam M. Interatrial shunt: diagnosis of patent foramen ovale and atrial septal defect with 64- row coronary computed tomography angiography. Jpn J Radiol. 2011;29(8):576-82. http://dx.doi.org/10.1007/s11604-011-0602-x. PMid:21928000.

15. Incedayi M, Ozturk E, Sonmez G, et al. The incidence of left atrial diverticula in coronary CT angiography. Diagn Interv Radiol. 2012;18(6):542-6. PMid:22801868.

16. Vural M, Ucar O, Selvi NA, et al. Assessment of global left ventricular systolic function with multidetector CT and 2D echocardiography: a comparison between reconstructions of 1-mm and 2-mm slice thickness at multidetector CT. Diagn Interv Radiol. 2010;16(3):236-40. PMid:20635319.

17. Kara K, Sivrioğlu AK, Öztürk E, et al. The role of coronary CT angiography in diagnosis of patent foramen ovale. Diagn Interv Radiol. 2016;22(4):341-6. http://dx.doi.org/10.5152/dir.2016.15570. PMid:27152642.

18. Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-8. http://dx.doi.org/10.1016/S0140-6736(97)08140-3. PMid:9428249.

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