Cargando…

The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations

BACKGROUND : Vein sclerosing therapy for varicose veins remains an extremely popular procedure. Cerebrovascular accidents can be a serious complication. A patent foramen ovale (PFO) can act as a conduit to the arterial circulation, which could explain the adverse neurologic consequence of this proce...

Descripción completa

Detalles Bibliográficos
Autores principales: Gajo, Eileen C, Kavinsky, Clifford J, Murphy, Joshua, Suradi, Hussam S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422334/
https://www.ncbi.nlm.nih.gov/pubmed/34514300
http://dx.doi.org/10.1093/ehjcr/ytab228
_version_ 1783749265571446784
author Gajo, Eileen C
Kavinsky, Clifford J
Murphy, Joshua
Suradi, Hussam S
author_facet Gajo, Eileen C
Kavinsky, Clifford J
Murphy, Joshua
Suradi, Hussam S
author_sort Gajo, Eileen C
collection PubMed
description BACKGROUND : Vein sclerosing therapy for varicose veins remains an extremely popular procedure. Cerebrovascular accidents can be a serious complication. A patent foramen ovale (PFO) can act as a conduit to the arterial circulation, which could explain the adverse neurologic consequence of this procedure. This case provides pathologic evidence of this concept. CASE SUMMARY : A 66-year-old female presented with syncope after undergoing varicose vein sclerotherapy. A computed tomography angiography of the head and neck in the emergency room revealed an occluded right distal M1 middle cerebral artery. Clot retrieval was performed with final pathology revealing amorphous material consistent with an exogenous agent, polidocanol foam, which was used for the patient’s vein sclerotherapy. A transthoracic echocardiogram and transoesophageal echocardiogram showed a PFO, which was ultimately closed percutaneously. DISCUSSION : In a quarter of the population, lack of closure of the intrauterine interatrial shunt leads to the existence of a PFO. This direct communication between the atria provides an anatomical conduit for paradoxical emboli and eventually infarction of affected tissues. While a paradoxical embolism is an uncommon cause of acute arterial occlusion, it can have catastrophic sequelae. Historically, the presence of an arterial thrombus from the venous circulation has been difficult to establish unless the thrombus is visualized in transit through a PFO. Complications from vein sclerotherapy have been reported in the literature and include transient ischaemic attacks and strokes, however, this is the first case to provide pathological proof of a paradoxical embolism, which ultimately resulted in percutaneous closure of the PFO.
format Online
Article
Text
id pubmed-8422334
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-84223342021-09-09 The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations Gajo, Eileen C Kavinsky, Clifford J Murphy, Joshua Suradi, Hussam S Eur Heart J Case Rep Case Report BACKGROUND : Vein sclerosing therapy for varicose veins remains an extremely popular procedure. Cerebrovascular accidents can be a serious complication. A patent foramen ovale (PFO) can act as a conduit to the arterial circulation, which could explain the adverse neurologic consequence of this procedure. This case provides pathologic evidence of this concept. CASE SUMMARY : A 66-year-old female presented with syncope after undergoing varicose vein sclerotherapy. A computed tomography angiography of the head and neck in the emergency room revealed an occluded right distal M1 middle cerebral artery. Clot retrieval was performed with final pathology revealing amorphous material consistent with an exogenous agent, polidocanol foam, which was used for the patient’s vein sclerotherapy. A transthoracic echocardiogram and transoesophageal echocardiogram showed a PFO, which was ultimately closed percutaneously. DISCUSSION : In a quarter of the population, lack of closure of the intrauterine interatrial shunt leads to the existence of a PFO. This direct communication between the atria provides an anatomical conduit for paradoxical emboli and eventually infarction of affected tissues. While a paradoxical embolism is an uncommon cause of acute arterial occlusion, it can have catastrophic sequelae. Historically, the presence of an arterial thrombus from the venous circulation has been difficult to establish unless the thrombus is visualized in transit through a PFO. Complications from vein sclerotherapy have been reported in the literature and include transient ischaemic attacks and strokes, however, this is the first case to provide pathological proof of a paradoxical embolism, which ultimately resulted in percutaneous closure of the PFO. Oxford University Press 2021-08-23 /pmc/articles/PMC8422334/ /pubmed/34514300 http://dx.doi.org/10.1093/ehjcr/ytab228 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Gajo, Eileen C
Kavinsky, Clifford J
Murphy, Joshua
Suradi, Hussam S
The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations
title The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations
title_full The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations
title_fullStr The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations
title_full_unstemmed The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations
title_short The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations
title_sort pivotal role of pfo in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422334/
https://www.ncbi.nlm.nih.gov/pubmed/34514300
http://dx.doi.org/10.1093/ehjcr/ytab228
work_keys_str_mv AT gajoeileenc thepivotalroleofpfoinparadoxicalembolismfollowingvenoussclerotherapyauniquecasereportwithpathologicalcorrelations
AT kavinskycliffordj thepivotalroleofpfoinparadoxicalembolismfollowingvenoussclerotherapyauniquecasereportwithpathologicalcorrelations
AT murphyjoshua thepivotalroleofpfoinparadoxicalembolismfollowingvenoussclerotherapyauniquecasereportwithpathologicalcorrelations
AT suradihussams thepivotalroleofpfoinparadoxicalembolismfollowingvenoussclerotherapyauniquecasereportwithpathologicalcorrelations
AT gajoeileenc pivotalroleofpfoinparadoxicalembolismfollowingvenoussclerotherapyauniquecasereportwithpathologicalcorrelations
AT kavinskycliffordj pivotalroleofpfoinparadoxicalembolismfollowingvenoussclerotherapyauniquecasereportwithpathologicalcorrelations
AT murphyjoshua pivotalroleofpfoinparadoxicalembolismfollowingvenoussclerotherapyauniquecasereportwithpathologicalcorrelations
AT suradihussams pivotalroleofpfoinparadoxicalembolismfollowingvenoussclerotherapyauniquecasereportwithpathologicalcorrelations