Posted by Anne Pilotelle | No comments
Ma RWL, Pilotelle A, Paraskevas P, Parsi K. Three Cases of Stroke Following Peripheral Venous Interventions. Phlebology. 2010[in press]
Abstract
We report three cases of stroke complicating sclerotherapy. All three female patients experienced a right middle cerebral artery stroke causing dysphasia and left hemiparesis and all recovered completely. A patent foramen ovale (PFO) was found in each patient. The first incident occurred two days after foam ultrasound guided sclerotherapy (UGS) to treat a great saphenous vein (GSV) trunk. Paradoxical clot embolism (PCE) was presumed in this case where concurrent deep vein thrombosis (DVT) of the popliteal and medial gastrocnemius veins were detected on ultrasound. The second case occurred immediately at the completion of foam UGS and ambulatory phlebectomy to treat GSV tributaries. Paradoxical gas embolism (PGE) was demonstrated in this patient confirmed by visualization of bubbles in the right middle cerebral artery on CT angiography. The third case occurred one day after endovenous laser ablation (1470nm) and foam UGS to treat both great and small saphenous veins. No specific cause could be confirmed in this patient. Sodium tetradecyl sulphate (STS) foam was used in all three cases (3%, 16mL; 1.5%, 4mL and 3%, 25mL respectively). Here we review these cases and discuss the possible pathogenic mechanisms.
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