The past life and future of angiosclerosis treatment

Hemangiomas are developmental malformations of blood vessels and are broadly classified into strawberry hemangiomas, cavernous hemangiomas and trabecular hemangiomas. Most hemangiomas tend to be treated non-operatively because of their wide range, irregular shape and low rate of complete surgical removal. Among the non-surgical treatments, sclerotherapy is one of the more commonly used methods. The so-called sclerosing agent is a chemical agent that can cause irreversible vascular endothelial cell damage, eventually leading to vascular fibrosis and occlusion of the vascular lumen. Sclerotherapy for hemangioma refers to the injection of sclerosing agents into the tumor. Sclerosing agents have a destructive effect on the abnormal endothelial cells of hemangioma, inducing endothelial cell necrosis, thrombosis, and mechanized resorption. There are many kinds of sclerosing agents, the earliest ones include: hypertonic saline, high sugar, urea, elimination of hemorrhoids, etc. However, the efficacy is generally short and easy to recur, and later Pingyangmycin is applied, which is a chemotherapeutic drug that can destroy endothelial cells, but repeated application of large doses can lead to local skin necrosis, slow growth of the child and other side effects. At present, the commonly used is polyglaucine, polyglaucine can be mixed into foam by 1:2 and air to increase the contact area to push the blood, destroy the endothelial cells, or in the perivascular tissue to induce fibrous tissue proliferation and compression of the vessel wall to achieve the purpose of closure of the blood vessels, rare cheek flushing, allergy and chest tightness breathing difficulties, the dose is controlled within the range of 20ml, is generally safe. The ideal sclerosing agent should have the following conditions: (1) no systemic toxicity; (2) work only above a certain threshold concentration, which can be diluted to accurately control the sclerosing effect; (3) work only after a certain time of contact with endothelial cells, so that it is relatively more effective for areas with stagnant blood flow and relatively safer for deep veins with rapid blood flow; Ninth People’s Hospital affiliated to Shanghai Jiaotong University School of Medicine Zheng Jiawei, Department of Oral and Maxillofacial Surgery (4) does not cause allergic reactions; (5) has sufficient sclerosing effect on even the thickest vessels, but does not cause local tissue damage when spilling out of the vessels; (6) does not cause skin pigmentation or scarring; (7) does not cause capillary dilatation vascular clumping; (8) is completely soluble in saline; (9) is painless when injected; and (10) is inexpensive. Unfortunately, the ideal sclerosing agent that meets the above conditions does not exist. Detergent-based sclerosing agents such as sodium tetradecyl sulfate and polydodecanol (polyglaucine) have long been recognized as the sclerosing agents of choice because of their low side effects and positive efficacy.