N Sylvoz1, C Villier, S Blaise, C Seinturier, M Mallaret. 1. Service de pharmacovigilance, pharmacie Vercors, CHU Michallon, BP 217, 38043 Grenoble cedex 09, France. NSylvoz@chu-grenoble.fr
Abstract
OBJECTIVE: Polidocanol foam sclerotherapy is a treatment of symptomatic venous disease. This solution is highly valued by clinicians because of its high efficacy and excellent safety profile. Systemic adverse effects are rare. Some life-threatening reactions have been reported. We report a case of respiratory and cardiac arrest, and a literature review on the cardiac toxicity of polidocanol used within and outside their licensed indications. MAIN OUTCOME MEASURES: A 48-year-old woman, with a symptomatic venous disorder, CEAP grade C2, was treated by echosclerotherapy for a great saphenous vein. She developed a malaise and respiratory and cardiac arrest occurred within minutes after a 7 ml foam polidocanol injection. Cardiopulmonary resuscitation was immediately started before restoration of pulses. A literature search was done using the Medline database. RESULTS: Five cases of cardiac toxicity were reported with polidocanol, but four of them were used outside their licensed indications. Because of the very suggestive chronology and the lack of any other obvious etiology, this cardiac arrest was attributed to polidocanol. Initial ST-segment elevation and negativity of anaphylaxis markers suggest a direct myocardial toxicity. CONCLUSIONS: Clinicians should be aware of the possibility of little-known but potentially serious cardiac adverse reaction with polidacanol injection and be prepared to initiate cardiopulmonary resuscitation if needed.
OBJECTIVE:Polidocanol foam sclerotherapy is a treatment of symptomatic venous disease. This solution is highly valued by clinicians because of its high efficacy and excellent safety profile. Systemic adverse effects are rare. Some life-threatening reactions have been reported. We report a case of respiratory and cardiac arrest, and a literature review on the cardiac toxicity of polidocanol used within and outside their licensed indications. MAIN OUTCOME MEASURES: A 48-year-old woman, with a symptomatic venous disorder, CEAP grade C2, was treated by echosclerotherapy for a great saphenous vein. She developed a malaise and respiratory and cardiac arrest occurred within minutes after a 7 ml foam polidocanol injection. Cardiopulmonary resuscitation was immediately started before restoration of pulses. A literature search was done using the Medline database. RESULTS: Five cases of cardiac toxicity were reported with polidocanol, but four of them were used outside their licensed indications. Because of the very suggestive chronology and the lack of any other obvious etiology, this cardiac arrest was attributed to polidocanol. Initial ST-segment elevation and negativity of anaphylaxis markers suggest a direct myocardial toxicity. CONCLUSIONS: Clinicians should be aware of the possibility of little-known but potentially serious cardiac adverse reaction with polidacanol injection and be prepared to initiate cardiopulmonary resuscitation if needed.