Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia

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Abbreviations: DAO2: desaturation area; SpO2: peripheral oxygen saturation" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Suzana Pinheiro Pimenta, Renata Barbosa da Rocha, Bruno Guedes Baldi, Alexandre de Melo Kawassaki, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Suzana Pinheiro" "apellidos" => "Pimenta" ] 1 => array:2 [ "nombre" => "Renata Barbosa" "apellidos" => "da Rocha" ] 2 => array:2 [ "nombre" => "Bruno Guedes" "apellidos" => "Baldi" ] 3 => array:2 [ "nombre" => "Alexandre" "apellidos" => "de Melo Kawassaki" ] 4 => array:2 [ "nombre" => "Ronaldo Adib" "apellidos" => "Kairalla" ] 5 => array:2 [ "nombre" => "Carlos Roberto Ribeiro" "apellidos" => "Carvalho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S180759322202943X?idApp=UINPBA00004N" "url" => "/18075932/0000006500000009/v1_202212011511/S180759322202943X/v1_202212011511/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222029416" "issn" => "18075932" "doi" => "10.1590/S1807-59322010000900003" "estado" => "S300" "fechaPublicacion" => "2010-01-01" "aid" => "2941" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2010;65:831-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Clinical Science" "titulo" => "Regional intravenous anesthesia in knee arthroscopy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "831" "paginaFinal" => "835" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1-cln_65p831" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 215 "Ancho" => 415 "Tamanyo" => 14767 ] ] "descripcion" => array:1 [ "en" => "Variation of heart rates relative to time.1 - Variation of heart rates relative to time. HRBT: Heart Rate Before tourniquet, HRAT: After tourniquet, HRIDC: Inflation of the distal cuff, HRSI: Surgical incision, HRRT1: First minute after the release of the tourniquet, HRRT5: Fifth minute after the release of the tourniquet" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mahmut Arslan, Mehmet Cantürk, Dilşen Örnek, Mehmet Gamlı, Yaşar Pala, Bayazit Dikmen, Melekşah Basaran" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Mahmut" "apellidos" => "Arslan" ] 1 => array:2 [ "nombre" => "Mehmet" "apellidos" => "Cantürk" ] 2 => array:2 [ "nombre" => "Dilşen" "apellidos" => "Örnek" ] 3 => array:2 [ "nombre" => "Mehmet" "apellidos" => "Gamlı" ] 4 => array:2 [ "nombre" => "Yaşar" "apellidos" => "Pala" ] 5 => array:2 [ "nombre" => "Bayazit" "apellidos" => "Dikmen" ] 6 => array:2 [ "nombre" => "Melekşah" "apellidos" => "Basaran" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222029416?idApp=UINPBA00004N" "url" => "/18075932/0000006500000009/v1_202212011511/S1807593222029416/v1_202212011511/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Clinical Science" "titulo" => "Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "837" "paginaFinal" => "840" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Luiz Orlando, Jose Guilherme Mendes Pereira Caldas, Heloisa Galvão do Amaral Campos, Kenji Nishinari, Nelson Wolosker" "autores" => array:5 [ 0 => array:3 [ "nombre" => "José Luiz" "apellidos" => "Orlando" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "I" "identificador" => "af1-cln_65p837" ] ] ] 1 => array:3 [ "nombre" => "Jose Guilherme Mendes Pereira" "apellidos" => "Caldas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "II" "identificador" => "af2-cln_65p837" ] ] ] 2 => array:3 [ "nombre" => "Heloisa Galvão" "apellidos" => "do Amaral Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "I" "identificador" => "af1-cln_65p837" ] ] ] 3 => array:4 [ "nombre" => "Kenji" "apellidos" => "Nishinari" "email" => array:1 [ 0 => "marken@uol.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "III" "identificador" => "af3-cln_65p837" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "c1-cln_65p837" ] ] ] 4 => array:3 [ "nombre" => "Nelson" "apellidos" => "Wolosker" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "III" "identificador" => "af3-cln_65p837" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Plastic Surgery, Hospital A.C. Camargo, São Paulo, SP, Brazil" "etiqueta" => "I" "identificador" => "af1-cln_65p837" ] 1 => array:3 [ "entidad" => "Department of Radiology, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil" "etiqueta" => "II" "identificador" => "af2-cln_65p837" ] 2 => array:3 [ "entidad" => "Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo, SP, Brazil" "etiqueta" => "III" "identificador" => "af3-cln_65p837" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "c1-cln_65p837" "etiqueta" => "*" "correspondencia" => "Tel.: 5511 3063-1498" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1-cln_65p837" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 347 "Ancho" => 498 "Tamanyo" => 30978 ] ] "descripcion" => array:1 [ "en" => "Muscular lesion before treatment (a) and after treatment (b).- Muscular lesion before treatment (a) and after treatment (b)." ] ] ] "textoCompleto" => "INTRODUCTIONVenous malformations are the most common symptomatic vascular malformations.<a class="elsevierStyleCrossRef" href="#bib1">1</a> They consist of spongy tangles of veins of varying sizes, formed by venular capillaries, venules, and veins.<a class="elsevierStyleCrossRef" href="#bib2">2</a> They may be located in any portion of the body in a diffusely or delimited form.The superficial vascular malformations are associated with skin color modifications, which may present a bluish color and lead to aesthetic manifestations and, frequently, to a social phobia.<a class="elsevierStyleCrossRefs" href="#bib3">3,4</a> Deep venous malformations (DVMs) are located deeply in subcutaneous tissues or in the muscles and generally cause local pain.<a class="elsevierStyleCrossRefs" href="#bib2">2,3</a>Surgical excision does not produce good results because of its functional and aesthetic sequelae and because of the high recurrence rate.<a class="elsevierStyleCrossRefs" href="#bib5">5,6</a> Percutaneous injection of sclerosing agents into the lesion has become the mainstay of treatment.<a class="elsevierStyleCrossRefs" href="#bib7">7,8,9</a> Ethanol is considered the most powerful and effective sclerosing agent,<a class="elsevierStyleCrossRef" href="#bib10">10</a> but its use at high doses may cause complications, thus making this a high-risk treatment.<a class="elsevierStyleCrossRefs" href="#bib11">11,12</a>The use of ethanol at low doses administered in consecutive sessions on an outpatient basis has not yet been described in the literature. This may produce good clinical results with lower risk for patients. The goal of this study was to analyze the results of treating patients with DVMs with low doses of ethanol under local anesthesia, with a median follow-up of 18 months.MATERIAL AND METHODSThirty-nine patients with DVMs were treated on an outpatient basis by means of percutaneous sclerosis using low doses of ethanol under local anesthesia between July 1995 and June 2007 and were followed up prospectively. Twenty-nine were female (74.4%) and 10 were male (25.6%), with ages ranging from 11 to 59 years (median of 24 years). The length of follow-up ranged from six to 72 months, with a median of 18 months.The patients' clinical characteristics are presented in <a class="elsevierStyleCrossRef" href="#t1-cln_65p837">Table 1:</a><elsevierMultimedia ident="t1-cln_65p837"></elsevierMultimedia>Most of the lesions affected the lower limbs. The main symptom reported was pain, and most of the patients had not undergone any type of previous treatment.The lesions were classified according to their size. Using nuclear magnetic resonance imaging (MRI), we measured them along their longer axis and grouped them into 3 categories: small, for lesions measuring up to 3 cm (4 patients); medium, for lesions between 3 and 15 cm (27 patients); and large, for lesions greater than 15 cm (8 patients).Each patient underwent fortnightly therapeutic sessions of ethanol application. The most appropriate puncture site was chosen by means of palpation of the lesion to locate the point with the greatest volume (after MRI analysis). The ethanol application technique consisted of percutaneous puncture of the lesion<a class="elsevierStyleCrossRef" href="#bib13">13</a> using a 21 scalpel or a 30×7 mm needle. This was directed perpendicularly to the skin until it reached the anomalous venous space, which was confirmed by the presence of blood reflux. Following this, the radiological contrast medium sodium meglumine ioxaglate (Hexabrix 320) was injected manually in a slow and gradual manner. Under fluoroscopic control, the opacification of the anomalous space was monitored, with quantification of the conditions and volume of drainage into the venous system. Approximately 2 ml of 2% lidocaine hydrochloride was then injected, without vasoconstrictor. Next, the sclerosing agent was injected and the volume was calculated to be equal to the contrast used during the angiographic evaluation by respecting the maximum dose of 1 ml/kg. Immediately before removing the needle, another small quantity of anesthetic was injected with the aim of flushing out any ethanol residue still in the needle. Finally, the needle was removed from the puncture site and a slightly compressive dressing was applied for 24 hours. The patient remained under observation for around 30 minutes and was then discharged.The final evaluation of the venous lesions was based on clinical (milimetric measurement of the circumference at the site of largest volume of the lesion) and radiological (MRI) parameters, ascertained before and after treatment. The clinical evolution following alcohol application, the reduction in the size of the lesions, the number of alcohol application sessions, and the complications related to the procedure were evaluated.STATISTICAL ANALYSISFrequency distribution was used to describe the categorical variables, and central trend and variability measurements were used for the numerical variables. To investigate the relationship between the results before and after the embolization treatment, the McNemar test was applied. The Mann-Whitney U test was used to compare the number of sessions for variables with 2 categories, and the Kruskal-Wallis test was used for variables with 3 categories. A significance level of 5% was used for all of the statistical tests.RESULTSAfter the treatment, the symptoms completely disappeared in 14 patients (35.9%) and improved in 24 (61.5%). They remained unchanged in only 1 patient (2.6%). The lesion size reduced to zero in 6 patients (15.4%) and decreased in 32 (82%). It remained unchanged in only 1 patient (2.6%). The evolution of DVM size compared with the initial size of the lesion is presented in <a class="elsevierStyleCrossRef" href="#t2-cln_65p837">Table 2:</a><elsevierMultimedia ident="t2-cln_65p837"></elsevierMultimedia>The treatment was effective, independent of the lesion size.The number of sessions held for treatment of DVMs is presented in <a class="elsevierStyleCrossRef" href="#t3-cln_65p837">Table 3:</a><elsevierMultimedia ident="t3-cln_65p837"></elsevierMultimedia>The number of sessions ranged from 3 to 34, with a median of 7. The number was statistically the same independently the size of the DVM.<a class="elsevierStyleCrossRef" href="#fig1-cln_65p837">Figures 1a</a> (before treatment) and <a class="elsevierStyleCrossRef" href="#fig1-cln_65p837">1b</a> (after treatment) show a patient with a muscular lesion in his calf:<elsevierMultimedia ident="fig1-cln_65p837"></elsevierMultimedia>There were no complications in 32 patients (82%), while 3 presented local paresthesia (7.7%), 2 superficial thrombophlebitis (5.1%), 1 skin ulcer (2.6%) and 1 case of hyperpigmentation (2.6%). All of the complications were treated conservatively, with good evolution.DISCUSSIONDVMs are characterized by venous tumor formation with soft consistency that can be depressed by palpation, without any arterial tremor, murmur, or beat involving the subcutaneous cellular tissue.<a class="elsevierStyleCrossRef" href="#bib3">3</a> They are present from the time of birth and present slow growth as the individual develops. They do not undergo spontaneous involution, unlike hemangiomas, which present rapid growth followed by stabilization or spontaneous involution.<a class="elsevierStyleCrossRef" href="#bib14">14</a>They may be located in any region of the body, but most of them affect the limbs,<a class="elsevierStyleCrossRef" href="#bib3">3</a> as seen in the present sample. Pain is the main complaint, and it is directly related to the size of the lesion (because of compression of the neighboring tissue) as well as to inflammatory processes resulting from phlebitis.In most cases, DVMs do not cause trophic skin lesions or cardiovascular manifestations. Occurrences of thrombophlebitis are common and usually caused by stagnant blood flow. If such conditions occur repeatedly, it leads to the formation of calcifications known as phleboliths, which can be seen on simple radiographs.<a class="elsevierStyleCrossRef" href="#bib2">2</a>The diagnosis of venous malformations is primarily clinical. If there is a suspicion that deep structures may be involved, especially in extensive lesions, complementary imaging examinations should be performed.<a class="elsevierStyleCrossRef" href="#bib15">15</a> The best imaging examination is magnetic resonance imaging.<a class="elsevierStyleCrossRef" href="#bib16">16</a> On T2-weighted or inversion-recovery sequences, DVMs consist of hyperintense channels or areas containing septation. Small fluid levels may be visible. Phleboliths may be evident as areas of signal void. Direct percutaneous cannulation of the malformation with contrast injection typically shows best the interconnecting spaces and draining veins.<a class="elsevierStyleCrossRef" href="#bib12">12</a>Ultrasonography may be used to distinguish between lesions of high and low flow rates and to assist in locating them. Recently, it has been used as a tool for guiding percutaneous punctures during sclerotherapy sessions.<a class="elsevierStyleCrossRefs" href="#bib17">17,18</a> The percutaneous route for treating DVMs began to be used because it allows direct contact between the sclerosing agent and the vascular endothelium. Many different sclerosing agents have been used, including ehtibloc, sodium tetradecil sulphate, polydocanol, and ethanol.<a class="elsevierStyleCrossRef" href="#bib19">19</a>Sodium tetradecyl sulphate (sotradecol) and polidocanol present detergent action that causes endothelial damage by interfering with the lipids on the cell surface.<a class="elsevierStyleCrossRefs" href="#bib20">20,21</a> However, the efficacy of these agents decreases in the presence of greater volume of blood that frequently occurs inside these anomalous cavities. In the same way as ethanol, these sclerosing agents cause endothelial lesions resulting in thrombosis and fibrosis, but there is a great tendency toward recanalization.<a class="elsevierStyleCrossRefs" href="#bib10">10,22</a> Furthermore, the use of sotradecol to treat extensive localized venous anomalies in the cephalic segment causes significant complications such as anaphylactic shock and loss of vision.<a class="elsevierStyleCrossRefs" href="#bib7">7,23</a>Ethibloc<a class="elsevierStyleCrossRef" href="#bib24">24</a> is a highly viscous sclerosing agent with a poorly understood mechanism of action. The efficacy of the agent is related to the presence of 60% ethanol in its composition.<a class="elsevierStyleCrossRef" href="#bib9">9</a> Ethanol deserves attention because of its potent fibrosing action, known and controllable side effects, low cost, and ease of availability.<a class="elsevierStyleCrossRefs" href="#bib8">8,25,26</a> Direct contact between ethanol and the vascular endothelium promotes the denaturing of blood proteins, necrosis of the vessel wall, breakup of erythrocytes, and subsequent thrombosis, which then leads to fibrosis of the intima, with regression of the malformation.<a class="elsevierStyleCrossRef" href="#bib27">27</a>The ethanol dose used during intervention procedures is strongly correlated with the serum level of ethanol in these patients. Because of the toxic action of ethanol, occurrences of side effects are related directly to the quantity of the agent injected into the organism. Doses greater than 1.0 ml/kg may lead to respiratory depression, cardiac arrhythmia, rhabdomyolysis, and hypoglycemia.<a class="elsevierStyleCrossRefs" href="#bib10">10,28</a>The great many studies have described the use of large volumes of ethanol under general anesthesia. However, many types of complications have been found, including the following: immediate thrombosis inside the lesion and blockage of the venous circulation, thereby leading to severe edema;<a class="elsevierStyleCrossRef" href="#bib29">29</a> superficial thrombophlebitis; deep vein thrombosis alone or complicated with pulmonary embolism;<a class="elsevierStyleCrossRefs" href="#bib9">9,11</a> cardiac arrest;<a class="elsevierStyleCrossRef" href="#bib10">10</a> trophic skin scars or lesions;<a class="elsevierStyleCrossRef" href="#bib30">30</a> and even death secondary to cardiovascular collapse.<a class="elsevierStyleCrossRefs" href="#bib31">31,32</a>All patients tolerated the consecutive procedures well, though there was a little local discomfort, in some cases, at the end of the sclerosing agent injection. The use of low-dose ethanol minimizes the occurrence of side effects and local complications such as thrombophlebitis in the drainage veins. Moreover, with local anesthesia, the patients were able to return to their activities the day after the procedure was performed.A disadvantage in this casuistic was the utilization of radioscopy during the procedure, although of short duration. More recently, we have been using ultrasonography<a class="elsevierStyleCrossRefs" href="#bib33">33,34</a> during the procedure, which – besides not requiring ionizing radiation – allows precise localization of the puncture site and the quantification of the volume of the sclerosing agent injected.The number of ethanol sessions was similar for all sizes of lesions, but the treatment was effective independent of the lesion size, given that partial or complete reduction of the lesions occurred in all of the groups. Percutaneous treatment for DVMs on an outpatient basis was effective since the symptoms disappeared or improved in 97.4% of the patients.CONCLUSIONOutpatient treatment for DVM patients using ethanol at low doses was effective, with a low complication rate." "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xpalclavsec1582497" "titulo" => "KEYWORDS" ] 1 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 2 => array:2 [ "identificador" => "cesec20" "titulo" => "MATERIAL AND METHODS" ] 3 => array:2 [ "identificador" => "cesec30" "titulo" => "STATISTICAL ANALYSIS" ] 4 => array:2 [ "identificador" => "cesec40" "titulo" => "RESULTS" ] 5 => array:2 [ "identificador" => "cesec50" "titulo" => "DISCUSSION" ] 6 => array:2 [ "identificador" => "cesec60" "titulo" => "CONCLUSION" ] 7 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-05-18" "fechaAceptado" => "2010-06-03" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "KEYWORDS" "identificador" => "xpalclavsec1582497" "palabras" => array:5 [ 0 => "Venous malformations" 1 => "Percutaneous" 2 => "Sclerotherapy" 3 => "Ethanol" 4 => "Local anesthesia" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "INTRODUCTION:Venous malformations are the most frequent vascular malformation. Deep venous malformations are located in subcutaneous tissue or in the muscles. Percutaneous sclerotherapy is the treatment of choice, and the use of ethanol at low doses has not yet been described. OBJECTIVE:To analyze the results of treating Deep venous malformations patients with low doses of ethanol. METHODS:Thirty-nine patients treated between July 1995 and June 2007 were followed up prospectively over a median period of 18 months. Twenty-nine were female (74.4%) and 10 were male (25.6%), with ages ranging from 11 to 59 years (median of 24 years). All of the lesions affected limbs, and the main symptom reported was pain (97.4%). Each patient underwent fortnightly alcohol application sessions under local anesthesia on an outpatient basis. The lesions were classified into three groups according to size using nuclear magnetic resonance imaging: small, up to 3 cm (4 patients); medium, between 3 and 15 cm (27 patients); and large, greater than 15 cm (8 patients). RESULTS:The symptoms completely disappeared in 14 patients (35.9%) and improved in 24 (61.5%). The lesion size reduced to zero in 6 patients (15.4%) and decreased in 32 (82%). The median number of sessions was 7. There were no complications in 32 patients (82%), while 3 presented local paresthesia (7.7%), 2 superficial trombophlebites (5.1%), 1 skin ulcer (2.6%), and 1 case of hyperpigmentation (2.6%). CONCLUSION:Outpatient treatment for Deep venous malformations patients using ethanol at low doses was effective, with a low complication rate." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "ceabs10" "titulo" => "INTRODUCTION:" ] 1 => array:2 [ "identificador" => "ceabs20" "titulo" => "OBJECTIVE:" ] 2 => array:2 [ "identificador" => "ceabs30" "titulo" => "METHODS:" ] 3 => array:2 [ "identificador" => "ceabs40" "titulo" => "RESULTS:" ] 4 => array:2 [ "identificador" => "ceabs50" "titulo" => "CONCLUSION:" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig1-cln_65p837" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 347 "Ancho" => 498 "Tamanyo" => 30978 ] ] "descripcion" => array:1 [ "en" => "Muscular lesion before treatment (a) and after treatment (b).- Muscular lesion before treatment (a) and after treatment (b)." ] ] 1 => array:7 [ "identificador" => "t1-cln_65p837" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Lesion location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Lower limb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">28 (71,8 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Upper limb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">11 (28,2 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Clinical manifestation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">38 (97,4 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Other symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">1 (2,6 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Previous treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">31 (79,5 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Surgery,biopsy or embolization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">8 (20,5 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics." ] ] 2 => array:7 [ "identificador" => "t2-cln_65p837" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "n = number of patients" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Decrease n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Unchanged n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Small \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">4 (100,0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">26 (96,3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">1 (3,7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Large \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">8 (100,0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Evolution of lesion size." ] ] 3 => array:7 [ "identificador" => "t3-cln_65p837" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "n = number of sessions SD = standard deviationp - value obtained from Kruskal-Wallis test" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Range (n) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Median (n) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Mean (n) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Small \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">3 - 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">4,8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">1,5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">3 - 34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">11,3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">9,4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0,1168 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Large \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">4 - 23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">12,6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">6,7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Number of sessions (n)." ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of venous malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ DA Loose \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1177/026835550702200608" "Revista" => array:6 [ "tituloSerie" => "Phlebology" "fecha" => "2007" "volumen" => "22" "paginaInicial" => "276" "paginaFinal" => "282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18274335" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1177/026835550702200608" "WWW" => array:1 [ "link" => "10.1258/026835507782655254" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and surgical aspectes of congenital venous angiodysplasia in the extremities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ E Paes \n \t\t\t\t\t\t\t\t """ 1 => """ J Vollmar \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Phlebology" "fecha" => "1995" "volumen" => "10" "paginaInicial" => "160" "paginaFinal" => "164" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital vascular lesions: clinical application of a new classification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ MC Finn \n \t\t\t\t\t\t\t\t """ 1 => """ J Glowacki \n \t\t\t\t\t\t\t\t """ 2 => """ JB Mulliken \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/s0022-3468(83)80043-8" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "1983" "volumen" => "18" "paginaInicial" => "894" "paginaFinal" => "900" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6663421" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/s0022-3468(83)80043-8" "WWW" => array:1 [ "link" => "10.1016/S0022-3468(83)80043-8" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous malformations. Diagnosis and treatment during the childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ S Rivas \n \t\t\t\t\t\t\t\t """ 1 => """ JC López-Gutiérrez \n \t\t\t\t\t\t\t\t """ 2 => """ M Díaz \n \t\t\t\t\t\t\t\t """ 3 => """ AM Andrés \n \t\t\t\t\t\t\t\t """ 4 => """ Z Ros \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cir Pediatr" "fecha" => "2006" "volumen" => "19" "paginaInicial" => "77" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16846128" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital arteriovenous anomalies of the limbs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ DE Szilagyi \n \t\t\t\t\t\t\t\t """ 1 => """ RF Smith \n \t\t\t\t\t\t\t\t """ 2 => """ JD Elliott \n \t\t\t\t\t\t\t\t """ 3 => """ JH Hageerman \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archsurg.1976.01360220119020" "Revista" => array:6 [ "tituloSerie" => "Arch Surg" "fecha" => "1976" "volumen" => "111" "paginaInicial" => "423" "paginaFinal" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1259580" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malformations Vasculares Des Membres: Place de la chirurgie vasculaire et réparatrice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ C Laurian \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Mal Vas" "fecha" => "1992" "volumen" => "17" "paginaInicial" => "57" "paginaFinal" => "60" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerotherapy for venous malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ AA de Lorimier \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/0022-3468(95)90558-8" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "1995" "volumen" => "30" "paginaInicial" => "188" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7738736" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/0022-3468(95)90558-8" "WWW" => array:1 [ "link" => "10.1016/0022-3468(95)90558-8" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of venous malformation by direct injection with ethanol" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ PK Shireman \n \t\t\t\t\t\t\t\t """ 1 => """ WJ Mccarthy \n \t\t\t\t\t\t\t\t """ 2 => """ JST Yao \n \t\t\t\t\t\t\t\t """ 3 => """ RL Vogelzang \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/s0741-5214(97)70098-3" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "1997" "volumen" => "26" "paginaInicial" => "838" "paginaFinal" => "844" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9372823" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/s0741-5214(97)70098-3" "WWW" => array:1 [ "link" => "10.1016/S0741-5214(97)70098-3" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ethanol embolization of vascular malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ WF Yakes \n \t\t\t\t\t\t\t\t """ 1 => """ JM Luethke \n \t\t\t\t\t\t\t\t """ 2 => """ SH Parker \n \t\t\t\t\t\t\t\t """ 3 => """ AT Stavros \n \t\t\t\t\t\t\t\t """ 4 => """ KM Rak \n \t\t\t\t\t\t\t\t """ 5 => """ KD Hopper \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiographics.10.5.2217971" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "1990" "volumen" => "10" "paginaInicial" => "787" "paginaFinal" => "796" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2217971" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous treatment of low flow vascular malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ PE Burrows \n \t\t\t\t\t\t\t\t """ 1 => """ KP Mason \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.rvi.0000124949.24134.cf" "Revista" => array:6 [ "tituloSerie" => "J Vasc Interv Radiol" "fecha" => "2004" "volumen" => "15" "paginaInicial" => "431" "paginaFinal" => "445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15126652" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advanced management of venous malformation with ethanol sclerotherapy: mid-term results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ BB Lee \n \t\t\t\t\t\t\t\t """ 1 => """ YS Do \n \t\t\t\t\t\t\t\t """ 2 => """ HS Byun \n \t\t\t\t\t\t\t\t """ 3 => """ IW Choo \n \t\t\t\t\t\t\t\t """ 4 => """ DI Kim \n \t\t\t\t\t\t\t\t """ 5 => """ SH Huh \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1067/mva.2003.91" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2003" "volumen" => "37" "paginaInicial" => "533" "paginaFinal" => "538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12618688" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1067/mva.2003.91" "WWW" => array:1 [ "link" => "10.1067/mva.2003.91" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum ethanol levels in children and adults after ethanol embolization or sclerotherapy for vascular anomalies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ KP Mason \n \t\t\t\t\t\t\t\t """ 1 => """ E Michna \n \t\t\t\t\t\t\t\t """ 2 => """ D Zurakowski \n \t\t\t\t\t\t\t\t """ 3 => """ BV Koka \n \t\t\t\t\t\t\t\t """ 4 => """ PE Burrows \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.217.1.r00se30127" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2000" "volumen" => "217" "paginaInicial" => "127" "paginaFinal" => "132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11012433" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diretc puncture angiography in congenital venous malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ Ml Boxt \n \t\t\t\t\t\t\t\t """ 1 => """ DC Levin \n \t\t\t\t\t\t\t\t """ 2 => """ KE Felows \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.140.1.135" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "1983" "volumen" => "140" "paginaInicial" => "135" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6600301" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemangiomas and vascular malformations in infants and children: A classification based on endotelial characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ JB Mulliken \n \t\t\t\t\t\t\t\t """ 1 => """ J Glowacki \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1097/00006534-198203000-00002" "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "1982" "volumen" => "69" "paginaInicial" => "412" "paginaFinal" => "422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7063565" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1097/00006534-198203000-00002" "WWW" => array:1 [ "link" => "10.1097/00006534-198203000-00002" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Soft-tissue venous malformations in adult patients: imaging and therapeutic issues" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ J Dubois \n \t\t\t\t\t\t\t\t """ 1 => """ G Soulez \n \t\t\t\t\t\t\t\t """ 2 => """ VL Oliva \n \t\t\t\t\t\t\t\t """ 3 => """ MJ Berthiaume \n \t\t\t\t\t\t\t\t """ 4 => """ C Lapierre \n \t\t\t\t\t\t\t\t """ 5 => """ E Therasse \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiographics.21.6.g01nv031519" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2001" "volumen" => "21" "paginaInicial" => "1519" "paginaFinal" => "1531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11706222" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetic resonance imaging of intramuscular haemangiomas with emphasis on contrast enhancement patterns" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ A Memis \n \t\t\t\t\t\t\t\t """ 1 => """ R Arkun \n \t\t\t\t\t\t\t\t """ 2 => """ EE Ustun \n \t\t\t\t\t\t\t\t """ 3 => """ G Kandiloglu \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/s0009-9260(96)80323-0" "Revista" => array:6 [ "tituloSerie" => "Clin Radiol" "fecha" => "1996" "volumen" => "51" "paginaInicial" => "198" "paginaFinal" => "204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8605751" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1016/s0009-9260(96)80323-0" "WWW" => array:1 [ "link" => "10.1016/S0009-9260(96)80323-0" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ J Dubois \n \t\t\t\t\t\t\t\t """ 1 => """ HB Patriquin \n \t\t\t\t\t\t\t\t """ 2 => """ L Garel \n \t\t\t\t\t\t\t\t """ 3 => """ J Powell \n \t\t\t\t\t\t\t\t """ 4 => """ D Filiatrault \n \t\t\t\t\t\t\t\t """ 5 => """ M David \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.171.1.9648798" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "1998" "volumen" => "171" "paginaInicial" => "247" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9648798" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined sonographic and fluoroscopic guidance: a modified technique for percutaneous sclerosis of low-flow vascular malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ LF Donnelly \n \t\t\t\t\t\t\t\t """ 1 => """ GS Bissett 3rd \n \t\t\t\t\t\t\t\t """ 2 => """ DM Adams \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.173.3.10470897" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "1999" "volumen" => "173" "paginaInicial" => "655" "paginaFinal" => "657" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10470897" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerotherapy after embolization of draining vein: a safe treatment method for venous malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ Y Jin \n \t\t\t\t\t\t\t\t """ 1 => """ X Lin \n \t\t\t\t\t\t\t\t """ 2 => """ W Li \n \t\t\t\t\t\t\t\t """ 3 => """ X Hu \n \t\t\t\t\t\t\t\t """ 4 => """ G Ma \n \t\t\t\t\t\t\t\t """ 5 => """ W Wang \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jvs.2008.01.010" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "1292" "paginaFinal" => "1299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18387776" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous angiomata: treatment with sclerosant foam" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ L Pascarella \n \t\t\t\t\t\t\t\t """ 1 => """ JJ Bergan \n \t\t\t\t\t\t\t\t """ 2 => """ C Yamada \n \t\t\t\t\t\t\t\t """ 3 => """ L Mekenas \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1007/s10016-005-4656-z" "Revista" => array:6 [ "tituloSerie" => "Ann Vasc Surg" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "457" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15981122" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1007/s10016-005-4656-z" "WWW" => array:1 [ "link" => "10.1007/s10016-005-4656-z" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerosants in microfoam. A new approach in angiology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ J Cabrera \n \t\t\t\t\t\t\t\t """ 1 => """ J Cabrera Jr \n \t\t\t\t\t\t\t\t """ 2 => """ MA Garcia-Olmedo \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int Angiol" "fecha" => "2001" "volumen" => "20" "paginaInicial" => "322" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11782699" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ H Mimura \n \t\t\t\t\t\t\t\t """ 1 => """ S Kanazawa \n \t\t\t\t\t\t\t\t """ 2 => """ K Yasui \n \t\t\t\t\t\t\t\t """ 3 => """ H Fujiwara \n \t\t\t\t\t\t\t\t """ 4 => """ T Hyodo \n \t\t\t\t\t\t\t\t """ 5 => """ T Mukai \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.18926/AMO/51909" "Revista" => array:6 [ "tituloSerie" => "Acta Med Okayama" "fecha" => "2003" "volumen" => "57" "paginaInicial" => "227" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14679400" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous sclerotherapy of venous malformations of the head and neck using sodium tetradecyl sulphate (sotradecol)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ TM Siniluoto \n \t\t\t\t\t\t\t\t """ 1 => """ PA Svendsen \n \t\t\t\t\t\t\t\t """ 2 => """ GM Wikholm \n \t\t\t\t\t\t\t\t """ 3 => """ I Fogdestam \n \t\t\t\t\t\t\t\t """ 4 => """ S Edström \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.3109/02844319709085481" "Revista" => array:6 [ "tituloSerie" => "Scand J Plast Reconstr Surg Hand Surg" "fecha" => "1997" "volumen" => "31" "paginaInicial" => "145" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9232699" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.3109/02844319709085481" "WWW" => array:1 [ "link" => "10.3109/02844319709085481" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Les malformations vasculaires veineuses et leur traitement par ethibloc" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ D Herbreteau \n \t\t\t\t\t\t\t\t """ 1 => """ O Riche \n \t\t\t\t\t\t\t\t """ 2 => """ F Enjolras \n \t\t\t\t\t\t\t\t """ 3 => """ C 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"paginaInicial" => "318" "paginaFinal" => "322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7203892" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1097/00004424-198007000-00008" "WWW" => array:1 [ "link" => "10.1097/00004424-198007000-00008" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous aspiration and ethanol sclerotherapy for thyroid cysts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ F Monzani \n \t\t\t\t\t\t\t\t """ 1 => """ F Lippi \n \t\t\t\t\t\t\t\t """ 2 => """ O Goletti \n \t\t\t\t\t\t\t\t """ 3 => """ P Del Guerra \n \t\t\t\t\t\t\t\t """ 4 => """ N Caraccio \n \t\t\t\t\t\t\t\t """ 5 => """ PV Lippolis \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1210/jcem.78.3.8126160" "Revista" => array:6 [ "tituloSerie" => "J Clin 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"etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of microfoam sclerotherapy in a patient with Klippel-Trenaunay syndrome and a patent foramen ovale" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ P Redodo \n \t\t\t\t\t\t\t\t """ 1 => """ G Bastarrika \n \t\t\t\t\t\t\t\t """ 2 => """ A Sierra \n \t\t\t\t\t\t\t\t """ 3 => """ A Martínez-Cuesta \n \t\t\t\t\t\t\t\t """ 4 => """ J Cabrera \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2009.210" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2009" "volumen" => "145" "paginaInicial" => "1147" "paginaFinal" => "1151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19841402" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1001/archdermatol.2009.210" "WWW" => array:1 [ "link" => "10.1001/archdermatol.2009.210" 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Clinical Science

José Luiz OrlandoI, Jose Guilherme Mendes Pereira CaldasII, Heloisa Galvão do Amaral CamposI, Kenji NishinariIII,

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marken@uol.com.br

Tel.: 5511 3063-1498

, Nelson WoloskerIII

I Department of Plastic Surgery, Hospital A.C. Camargo, São Paulo, SP, Brazil

II Department of Radiology, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

III Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo, SP, Brazil

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    "titulo" => "Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia"
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        "autoresLista" => "Jos&#233; Luiz Orlando, Jose Guilherme Mendes Pereira Caldas, Heloisa Galv&#227;o do Amaral Campos, Kenji Nishinari, Nelson Wolosker"
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Muscular lesion before treatment &#40;a&#41; and after treatment &#40;b&#41;&#46;- Muscular lesion before treatment &#40;a&#41; and after treatment &#40;b&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Venous malformations are the most common symptomatic vascular malformations&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> They consist of spongy tangles of veins of varying sizes&#44; formed by venular capillaries&#44; venules&#44; and veins&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> They may be located in any portion of the body in a diffusely or delimited form&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">The superficial vascular malformations are associated with skin color modifications&#44; which may present a bluish color and lead to aesthetic manifestations and&#44; frequently&#44; to a social phobia&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;4</a> Deep venous malformations &#40;DVMs&#41; are located deeply in subcutaneous tissues or in the muscles and generally cause local pain&#46;<a class="elsevierStyleCrossRefs" href="#bib2">2&#44;3</a></p><p id="para30" class="elsevierStylePara elsevierViewall">Surgical excision does not produce good results because of its functional and aesthetic sequelae and because of the high recurrence rate&#46;<a class="elsevierStyleCrossRefs" href="#bib5">5&#44;6</a> Percutaneous injection of sclerosing agents into the lesion has become the mainstay of treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7&#44;8&#44;9</a> Ethanol is considered the most powerful and effective sclerosing agent&#44;<a class="elsevierStyleCrossRef" href="#bib10">10</a> but its use at high doses may cause complications&#44; thus making this a high-risk treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib11">11&#44;12</a></p><p id="para40" class="elsevierStylePara elsevierViewall">The use of ethanol at low doses administered in consecutive sessions on an outpatient basis has not yet been described in the literature&#46; This may produce good clinical results with lower risk for patients&#46; The goal of this study was to analyze the results of treating patients with DVMs with low doses of ethanol under local anesthesia&#44; with a median follow-up of 18 months&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">MATERIAL AND METHODS</span><p id="para50" class="elsevierStylePara elsevierViewall">Thirty-nine patients with DVMs were treated on an outpatient basis by means of percutaneous sclerosis using low doses of ethanol under local anesthesia between July 1995 and June 2007 and were followed up prospectively&#46; Twenty-nine were female &#40;74&#46;4&#37;&#41; and 10 were male &#40;25&#46;6&#37;&#41;&#44; with ages ranging from 11 to 59 years &#40;median of 24 years&#41;&#46; The length of follow-up ranged from six to 72 months&#44; with a median of 18 months&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">The patients&#39; clinical characteristics are presented in <a class="elsevierStyleCrossRef" href="#t1-cln_65p837">Table 1&#58;</a></p><elsevierMultimedia ident="t1-cln_65p837"></elsevierMultimedia><p id="para70" class="elsevierStylePara elsevierViewall">Most of the lesions affected the lower limbs&#46; The main symptom reported was pain&#44; and most of the patients had not undergone any type of previous treatment&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">The lesions were classified according to their size&#46; Using nuclear magnetic resonance imaging &#40;MRI&#41;&#44; we measured them along their longer axis and grouped them into 3 categories&#58; small&#44; for lesions measuring up to 3 cm &#40;4 patients&#41;&#59; medium&#44; for lesions between 3 and 15 cm &#40;27 patients&#41;&#59; and large&#44; for lesions greater than 15 cm &#40;8 patients&#41;&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">Each patient underwent fortnightly therapeutic sessions of ethanol application&#46; The most appropriate puncture site was chosen by means of palpation of the lesion to locate the point with the greatest volume &#40;after MRI analysis&#41;&#46; The ethanol application technique consisted of percutaneous puncture of the lesion<a class="elsevierStyleCrossRef" href="#bib13">13</a> using a 21 scalpel or a 30&#215;7 mm needle&#46; This was directed perpendicularly to the skin until it reached the anomalous venous space&#44; which was confirmed by the presence of blood reflux&#46; Following this&#44; the radiological contrast medium sodium meglumine ioxaglate &#40;Hexabrix 320&#41; was injected manually in a slow and gradual manner&#46; Under fluoroscopic control&#44; the opacification of the anomalous space was monitored&#44; with quantification of the conditions and volume of drainage into the venous system&#46; Approximately 2 ml of 2&#37; lidocaine hydrochloride was then injected&#44; without vasoconstrictor&#46; Next&#44; the sclerosing agent was injected and the volume was calculated to be equal to the contrast used during the angiographic evaluation by respecting the maximum dose of 1 ml&#47;kg&#46; Immediately before removing the needle&#44; another small quantity of anesthetic was injected with the aim of flushing out any ethanol residue still in the needle&#46; Finally&#44; the needle was removed from the puncture site and a slightly compressive dressing was applied for 24 hours&#46; The patient remained under observation for around 30 minutes and was then discharged&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">The final evaluation of the venous lesions was based on clinical &#40;milimetric measurement of the circumference at the site of largest volume of the lesion&#41; and radiological &#40;MRI&#41; parameters&#44; ascertained before and after treatment&#46; The clinical evolution following alcohol application&#44; the reduction in the size of the lesions&#44; the number of alcohol application sessions&#44; and the complications related to the procedure were evaluated&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">STATISTICAL ANALYSIS</span><p id="para110" class="elsevierStylePara elsevierViewall">Frequency distribution was used to describe the categorical variables&#44; and central trend and variability measurements were used for the numerical variables&#46; To investigate the relationship between the results before and after the embolization treatment&#44; the McNemar test was applied&#46; The Mann-Whitney U test was used to compare the number of sessions for variables with 2 categories&#44; and the Kruskal-Wallis test was used for variables with 3 categories&#46; A significance level of 5&#37; was used for all of the statistical tests&#46;</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">RESULTS</span><p id="para120" class="elsevierStylePara elsevierViewall">After the treatment&#44; the symptoms completely disappeared in 14 patients &#40;35&#46;9&#37;&#41; and improved in 24 &#40;61&#46;5&#37;&#41;&#46; They remained unchanged in only 1 patient &#40;2&#46;6&#37;&#41;&#46; The lesion size reduced to zero in 6 patients &#40;15&#46;4&#37;&#41; and decreased in 32 &#40;82&#37;&#41;&#46; It remained unchanged in only 1 patient &#40;2&#46;6&#37;&#41;&#46; The evolution of DVM size compared with the initial size of the lesion is presented in <a class="elsevierStyleCrossRef" href="#t2-cln_65p837">Table 2&#58;</a></p><elsevierMultimedia ident="t2-cln_65p837"></elsevierMultimedia><p id="para130" class="elsevierStylePara elsevierViewall">The treatment was effective&#44; independent of the lesion size&#46;</p><p id="para140" class="elsevierStylePara elsevierViewall">The number of sessions held for treatment of DVMs is presented in <a class="elsevierStyleCrossRef" href="#t3-cln_65p837">Table 3&#58;</a></p><elsevierMultimedia ident="t3-cln_65p837"></elsevierMultimedia><p id="para150" class="elsevierStylePara elsevierViewall">The number of sessions ranged from 3 to 34&#44; with a median of 7&#46; The number was statistically the same independently the size of the DVM&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig1-cln_65p837">Figures 1a</a> &#40;before treatment&#41; and <a class="elsevierStyleCrossRef" href="#fig1-cln_65p837">1b</a> &#40;after treatment&#41; show a patient with a muscular lesion in his calf&#58;</p><elsevierMultimedia ident="fig1-cln_65p837"></elsevierMultimedia><p id="para170" class="elsevierStylePara elsevierViewall">There were no complications in 32 patients &#40;82&#37;&#41;&#44; while 3 presented local paresthesia &#40;7&#46;7&#37;&#41;&#44; 2 superficial thrombophlebitis &#40;5&#46;1&#37;&#41;&#44; 1 skin ulcer &#40;2&#46;6&#37;&#41; and 1 case of hyperpigmentation &#40;2&#46;6&#37;&#41;&#46; All of the complications were treated conservatively&#44; with good evolution&#46;</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">DISCUSSION</span><p id="para180" class="elsevierStylePara elsevierViewall">DVMs are characterized by venous tumor formation with soft consistency that can be depressed by palpation&#44; without any arterial tremor&#44; murmur&#44; or beat involving the subcutaneous cellular tissue&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> They are present from the time of birth and present slow growth as the individual develops&#46; They do not undergo spontaneous involution&#44; unlike hemangiomas&#44; which present rapid growth followed by stabilization or spontaneous involution&#46;<a class="elsevierStyleCrossRef" href="#bib14">14</a></p><p id="para190" class="elsevierStylePara elsevierViewall">They may be located in any region of the body&#44; but most of them affect the limbs&#44;<a class="elsevierStyleCrossRef" href="#bib3">3</a> as seen in the present sample&#46; Pain is the main complaint&#44; and it is directly related to the size of the lesion &#40;because of compression of the neighboring tissue&#41; as well as to inflammatory processes resulting from phlebitis&#46;</p><p id="para200" class="elsevierStylePara elsevierViewall">In most cases&#44; DVMs do not cause trophic skin lesions or cardiovascular manifestations&#46; Occurrences of thrombophlebitis are common and usually caused by stagnant blood flow&#46; If such conditions occur repeatedly&#44; it leads to the formation of calcifications known as phleboliths&#44; which can be seen on simple radiographs&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a></p><p id="para210" class="elsevierStylePara elsevierViewall">The diagnosis of venous malformations is primarily clinical&#46; If there is a suspicion that deep structures may be involved&#44; especially in extensive lesions&#44; complementary imaging examinations should be performed&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a> The best imaging examination is magnetic resonance imaging&#46;<a class="elsevierStyleCrossRef" href="#bib16">16</a> On T2-weighted or inversion-recovery sequences&#44; DVMs consist of hyperintense channels or areas containing septation&#46; Small fluid levels may be visible&#46; Phleboliths may be evident as areas of signal void&#46; Direct percutaneous cannulation of the malformation with contrast injection typically shows best the interconnecting spaces and draining veins&#46;<a class="elsevierStyleCrossRef" href="#bib12">12</a></p><p id="para220" class="elsevierStylePara elsevierViewall">Ultrasonography may be used to distinguish between lesions of high and low flow rates and to assist in locating them&#46; Recently&#44; it has been used as a tool for guiding percutaneous punctures during sclerotherapy sessions&#46;<a class="elsevierStyleCrossRefs" href="#bib17">17&#44;18</a> The percutaneous route for treating DVMs began to be used because it allows direct contact between the sclerosing agent and the vascular endothelium&#46; Many different sclerosing agents have been used&#44; including ehtibloc&#44; sodium tetradecil sulphate&#44; polydocanol&#44; and ethanol&#46;<a class="elsevierStyleCrossRef" href="#bib19">19</a></p><p id="para230" class="elsevierStylePara elsevierViewall">Sodium tetradecyl sulphate &#40;sotradecol&#41; and polidocanol present detergent action that causes endothelial damage by interfering with the lipids on the cell surface&#46;<a class="elsevierStyleCrossRefs" href="#bib20">20&#44;21</a> However&#44; the efficacy of these agents decreases in the presence of greater volume of blood that frequently occurs inside these anomalous cavities&#46; In the same way as ethanol&#44; these sclerosing agents cause endothelial lesions resulting in thrombosis and fibrosis&#44; but there is a great tendency toward recanalization&#46;<a class="elsevierStyleCrossRefs" href="#bib10">10&#44;22</a> Furthermore&#44; the use of sotradecol to treat extensive localized venous anomalies in the cephalic segment causes significant complications such as anaphylactic shock and loss of vision&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7&#44;23</a></p><p id="para240" class="elsevierStylePara elsevierViewall">Ethibloc<a class="elsevierStyleCrossRef" href="#bib24">24</a> is a highly viscous sclerosing agent with a poorly understood mechanism of action&#46; The efficacy of the agent is related to the presence of 60&#37; ethanol in its composition&#46;<a class="elsevierStyleCrossRef" href="#bib9">9</a> Ethanol deserves attention because of its potent fibrosing action&#44; known and controllable side effects&#44; low cost&#44; and ease of availability&#46;<a class="elsevierStyleCrossRefs" href="#bib8">8&#44;25&#44;26</a> Direct contact between ethanol and the vascular endothelium promotes the denaturing of blood proteins&#44; necrosis of the vessel wall&#44; breakup of erythrocytes&#44; and subsequent thrombosis&#44; which then leads to fibrosis of the intima&#44; with regression of the malformation&#46;<a class="elsevierStyleCrossRef" href="#bib27">27</a></p><p id="para250" class="elsevierStylePara elsevierViewall">The ethanol dose used during intervention procedures is strongly correlated with the serum level of ethanol in these patients&#46; Because of the toxic action of ethanol&#44; occurrences of side effects are related directly to the quantity of the agent injected into the organism&#46; Doses greater than 1&#46;0 ml&#47;kg may lead to respiratory depression&#44; cardiac arrhythmia&#44; rhabdomyolysis&#44; and hypoglycemia&#46;<a class="elsevierStyleCrossRefs" href="#bib10">10&#44;28</a></p><p id="para260" class="elsevierStylePara elsevierViewall">The great many studies have described the use of large volumes of ethanol under general anesthesia&#46; However&#44; many types of complications have been found&#44; including the following&#58; immediate thrombosis inside the lesion and blockage of the venous circulation&#44; thereby leading to severe edema&#59;<a class="elsevierStyleCrossRef" href="#bib29">29</a> superficial thrombophlebitis&#59; deep vein thrombosis alone or complicated with pulmonary embolism&#59;<a class="elsevierStyleCrossRefs" href="#bib9">9&#44;11</a> cardiac arrest&#59;<a class="elsevierStyleCrossRef" href="#bib10">10</a> trophic skin scars or lesions&#59;<a class="elsevierStyleCrossRef" href="#bib30">30</a> and even death secondary to cardiovascular collapse&#46;<a class="elsevierStyleCrossRefs" href="#bib31">31&#44;32</a></p><p id="para270" class="elsevierStylePara elsevierViewall">All patients tolerated the consecutive procedures well&#44; though there was a little local discomfort&#44; in some cases&#44; at the end of the sclerosing agent injection&#46; The use of low-dose ethanol minimizes the occurrence of side effects and local complications such as thrombophlebitis in the drainage veins&#46; Moreover&#44; with local anesthesia&#44; the patients were able to return to their activities the day after the procedure was performed&#46;</p><p id="para280" class="elsevierStylePara elsevierViewall">A disadvantage in this casuistic was the utilization of radioscopy during the procedure&#44; although of short duration&#46; More recently&#44; we have been using ultrasonography<a class="elsevierStyleCrossRefs" href="#bib33">33&#44;34</a> during the procedure&#44; which &#8211; besides not requiring ionizing radiation &#8211; allows precise localization of the puncture site and the quantification of the volume of the sclerosing agent injected&#46;</p><p id="para290" class="elsevierStylePara elsevierViewall">The number of ethanol sessions was similar for all sizes of lesions&#44; but the treatment was effective independent of the lesion size&#44; given that partial or complete reduction of the lesions occurred in all of the groups&#46; Percutaneous treatment for DVMs on an outpatient basis was effective since the symptoms disappeared or improved in 97&#46;4&#37; of the patients&#46;</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">CONCLUSION</span><p id="para300" class="elsevierStylePara elsevierViewall">Outpatient treatment for DVM patients using ethanol at low doses was effective&#44; with a low complication rate&#46;</p></span></span>"
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION&#58;</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">Venous malformations are the most frequent vascular malformation&#46; Deep venous malformations are located in subcutaneous tissue or in the muscles&#46; Percutaneous sclerotherapy is the treatment of choice&#44; and the use of ethanol at low doses has not yet been described&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">OBJECTIVE&#58;</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">To analyze the results of treating Deep venous malformations patients with low doses of ethanol&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">METHODS&#58;</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">Thirty-nine patients treated between July 1995 and June 2007 were followed up prospectively over a median period of 18 months&#46; Twenty-nine were female &#40;74&#46;4&#37;&#41; and 10 were male &#40;25&#46;6&#37;&#41;&#44; with ages ranging from 11 to 59 years &#40;median of 24 years&#41;&#46; All of the lesions affected limbs&#44; and the main symptom reported was pain &#40;97&#46;4&#37;&#41;&#46; Each patient underwent fortnightly alcohol application sessions under local anesthesia on an outpatient basis&#46; The lesions were classified into three groups according to size using nuclear magnetic resonance imaging&#58; small&#44; up to 3 cm &#40;4 patients&#41;&#59; medium&#44; between 3 and 15 cm &#40;27 patients&#41;&#59; and large&#44; greater than 15 cm &#40;8 patients&#41;&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">RESULTS&#58;</span><p id="spara110" class="elsevierStyleSimplePara elsevierViewall">The symptoms completely disappeared in 14 patients &#40;35&#46;9&#37;&#41; and improved in 24 &#40;61&#46;5&#37;&#41;&#46; The lesion size reduced to zero in 6 patients &#40;15&#46;4&#37;&#41; and decreased in 32 &#40;82&#37;&#41;&#46; The median number of sessions was 7&#46; There were no complications in 32 patients &#40;82&#37;&#41;&#44; while 3 presented local paresthesia &#40;7&#46;7&#37;&#41;&#44; 2 superficial trombophlebites &#40;5&#46;1&#37;&#41;&#44; 1 skin ulcer &#40;2&#46;6&#37;&#41;&#44; and 1 case of hyperpigmentation &#40;2&#46;6&#37;&#41;&#46;</p></span> <span id="ceabs50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">CONCLUSION&#58;</span><p id="spara120" class="elsevierStyleSimplePara elsevierViewall">Outpatient treatment for Deep venous malformations patients using ethanol at low doses was effective&#44; with a low complication rate&#46;</p></span>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="justify" valign="top">Lesion location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Lower limb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">28 &#40;71&#44;8 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="justify" valign="top">Upper limb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">11 &#40;28&#44;2 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="justify" valign="top">Clinical manifestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="justify" valign="top">Pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">38 &#40;97&#44;4 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="justify" valign="top">Other symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1 &#40;2&#44;6 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="justify" valign="top">Previous treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="justify" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">31 &#40;79&#44;5 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="justify" valign="top">Surgery&#44;biopsy or embolization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">8 &#40;20&#44;5 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "t2-cln_65p837"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">n &#61; number of patients</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Decrease n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Unchanged n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Small&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">4 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">26 &#40;96&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Large&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">8 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Evolution of lesion size&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "t3-cln_65p837"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">n &#61; number of sessions SD &#61; standard deviation</p><p id="spara70" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">p</span> - value obtained from Kruskal-Wallis test</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Range &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Median &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">Mean &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Small&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">3 - 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">4&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Medium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">3 - 34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">11&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">9&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">0&#44;1168&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Large&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">4 - 23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">12&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara50" class="elsevierStyleSimplePara elsevierViewall">Number of sessions &#40;n&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of venous malformations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              DA Loose \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1177/026835550702200608"
                      "Revista" => array:6 [
                        "tituloSerie" => "Phlebology"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "276"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18274335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1177/026835550702200608"
                      "WWW" => array:1 [
                        "link" => "10&#46;1258&#47;026835507782655254"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and surgical aspectes of congenital venous angiodysplasia in the extremities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              E Paes \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Vollmar \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Phlebology"
                        "fecha" => "1995"
                        "volumen" => "10"
                        "paginaInicial" => "160"
                        "paginaFinal" => "164"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Congenital vascular lesions&#58; clinical application of a new classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              MC Finn \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Glowacki \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JB Mulliken \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0022-3468(83)80043-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Surg"
                        "fecha" => "1983"
                        "volumen" => "18"
                        "paginaInicial" => "894"
                        "paginaFinal" => "900"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6663421"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0022-3468(83)80043-8"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0022-3468&#40;83&#41;80043-8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous malformations&#46; Diagnosis and treatment during the childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              S Rivas \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JC L&#243;pez-Guti&#233;rrez \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              M D&#237;az \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              AM Andr&#233;s \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              Z Ros \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cir Pediatr"
                        "fecha" => "2006"
                        "volumen" => "19"
                        "paginaInicial" => "77"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16846128"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Congenital arteriovenous anomalies of the limbs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              DE Szilagyi \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RF Smith \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JD Elliott \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JH Hageerman \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archsurg.1976.01360220119020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "1976"
                        "volumen" => "111"
                        "paginaInicial" => "423"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1259580"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malformations Vasculares Des Membres&#58; Place de la chirurgie vasculaire et r&#233;paratrice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              C Laurian \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Mal Vas"
                        "fecha" => "1992"
                        "volumen" => "17"
                        "paginaInicial" => "57"
                        "paginaFinal" => "60"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sclerotherapy for venous malformations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              AA de Lorimier \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/0022-3468(95)90558-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Surg"
                        "fecha" => "1995"
                        "volumen" => "30"
                        "paginaInicial" => "188"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7738736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/0022-3468(95)90558-8"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;0022-3468&#40;95&#41;90558-8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of venous malformation by direct injection with ethanol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              PK Shireman \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              WJ Mccarthy \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JST Yao \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RL Vogelzang \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0741-5214(97)70098-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Surg"
                        "fecha" => "1997"
                        "volumen" => "26"
                        "paginaInicial" => "838"
                        "paginaFinal" => "844"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9372823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0741-5214(97)70098-3"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0741-5214&#40;97&#41;70098-3"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ethanol embolization of vascular malformations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              WF Yakes \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JM Luethke \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SH Parker \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              AT Stavros \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              KM Rak \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              KD Hopper \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiographics.10.5.2217971"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "1990"
                        "volumen" => "10"
                        "paginaInicial" => "787"
                        "paginaFinal" => "796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2217971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous treatment of low flow vascular malformations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              PE Burrows \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              KP Mason \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.rvi.0000124949.24134.cf"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Interv Radiol"
                        "fecha" => "2004"
                        "volumen" => "15"
                        "paginaInicial" => "431"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15126652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advanced management of venous malformation with ethanol sclerotherapy&#58; mid-term results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              BB Lee \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              YS Do \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              HS Byun \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              IW Choo \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              DI Kim \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              SH Huh \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1067/mva.2003.91"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Surg"
                        "fecha" => "2003"
                        "volumen" => "37"
                        "paginaInicial" => "533"
                        "paginaFinal" => "538"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12618688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1067/mva.2003.91"
                      "WWW" => array:1 [
                        "link" => "10&#46;1067&#47;mva&#46;2003&#46;91"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum ethanol levels in children and adults after ethanol embolization or sclerotherapy for vascular anomalies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              KP Mason \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              E Michna \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Zurakowski \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              BV Koka \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              PE Burrows \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiology.217.1.r00se30127"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2000"
                        "volumen" => "217"
                        "paginaInicial" => "127"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11012433"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diretc puncture angiography in congenital venous malformations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              Ml Boxt \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              DC Levin \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              KE Felows \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.140.1.135"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "1983"
                        "volumen" => "140"
                        "paginaInicial" => "135"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6600301"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemangiomas and vascular malformations in infants and children&#58; A classification based on endotelial characteristics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              JB Mulliken \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Glowacki \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/00006534-198203000-00002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "1982"
                        "volumen" => "69"
                        "paginaInicial" => "412"
                        "paginaFinal" => "422"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7063565"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/00006534-198203000-00002"
                      "WWW" => array:1 [
                        "link" => "10&#46;1097&#47;00006534-198203000-00002"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Soft-tissue venous malformations in adult patients&#58; imaging and therapeutic issues"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              J Dubois \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Soulez \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              VL Oliva \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MJ Berthiaume \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              C Lapierre \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              E Therasse \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiographics.21.6.g01nv031519"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "2001"
                        "volumen" => "21"
                        "paginaInicial" => "1519"
                        "paginaFinal" => "1531"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11706222"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Magnetic resonance imaging of intramuscular haemangiomas with emphasis on contrast enhancement patterns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              A Memis \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              R Arkun \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              EE Ustun \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              G Kandiloglu \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0009-9260(96)80323-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Radiol"
                        "fecha" => "1996"
                        "volumen" => "51"
                        "paginaInicial" => "198"
                        "paginaFinal" => "204"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8605751"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0009-9260(96)80323-0"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0009-9260&#40;96&#41;80323-0"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Soft-tissue hemangiomas in infants and children&#58; diagnosis using Doppler sonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              J Dubois \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              HB Patriquin \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              L Garel \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              J Powell \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              D Filiatrault \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              M David \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.171.1.9648798"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "1998"
                        "volumen" => "171"
                        "paginaInicial" => "247"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9648798"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Combined sonographic and fluoroscopic guidance&#58; a modified technique for percutaneous sclerosis of low-flow vascular malformations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              LF Donnelly \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              GS Bissett 3rd \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              DM Adams \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.173.3.10470897"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "1999"
                        "volumen" => "173"
                        "paginaInicial" => "655"
                        "paginaFinal" => "657"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10470897"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sclerotherapy after embolization of draining vein&#58; a safe treatment method for venous malformations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              Y Jin \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              X Lin \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              W Li \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              X Hu \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              G Ma \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              W Wang \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jvs.2008.01.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Surg"
                        "fecha" => "2008"
                        "volumen" => "47"
                        "paginaInicial" => "1292"
                        "paginaFinal" => "1299"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18387776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous angiomata&#58; treatment with sclerosant foam"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              L Pascarella \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JJ Bergan \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              C Yamada \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              L Mekenas \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/s10016-005-4656-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Vasc Surg"
                        "fecha" => "2005"
                        "volumen" => "19"
                        "paginaInicial" => "457"
                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15981122"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/s10016-005-4656-z"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;s10016-005-4656-z"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sclerosants in microfoam&#46; A new approach in angiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              J Cabrera \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Cabrera Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              MA Garcia-Olmedo \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Angiol"
                        "fecha" => "2001"
                        "volumen" => "20"
                        "paginaInicial" => "322"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11782699"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              H Mimura \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              S Kanazawa \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              K Yasui \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              H Fujiwara \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              T Hyodo \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              T Mukai \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.18926/AMO/51909"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Med Okayama"
                        "fecha" => "2003"
                        "volumen" => "57"
                        "paginaInicial" => "227"
                        "paginaFinal" => "234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14679400"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous sclerotherapy of venous malformations of the head and neck using sodium tetradecyl sulphate &#40;sotradecol&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              TM Siniluoto \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              PA Svendsen \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              GM Wikholm \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              I Fogdestam \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              S Edstr&#246;m \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.3109/02844319709085481"
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Plast Reconstr Surg Hand Surg"
                        "fecha" => "1997"
                        "volumen" => "31"
                        "paginaInicial" => "145"
                        "paginaFinal" => "150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9232699"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.3109/02844319709085481"
                      "WWW" => array:1 [
                        "link" => "10&#46;3109&#47;02844319709085481"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Les malformations vasculaires veineuses et leur traitement par ethibloc"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              D Herbreteau \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              O Riche \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              F Enjolras \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              C Lemarchand \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              C Laurian \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              JJ Merland \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Mal Vas"
                        "fecha" => "1992"
                        "volumen" => "17"
                        "paginaInicial" => "50"
                        "paginaFinal" => "53"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal infarction with absolute ethanol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              BA Ellman \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              CE Green \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              E Eigenbrodt \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JC Garriott \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              TS Curry \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/00004424-198007000-00008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Radiol"
                        "fecha" => "1980"
                        "volumen" => "15"
                        "paginaInicial" => "318"
                        "paginaFinal" => "322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7203892"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/00004424-198007000-00008"
                      "WWW" => array:1 [
                        "link" => "10&#46;1097&#47;00004424-198007000-00008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous aspiration and ethanol sclerotherapy for thyroid cysts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              F Monzani \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              F Lippi \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              O Goletti \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              P Del Guerra \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              N Caraccio \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              PV Lippolis \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1210/jcem.78.3.8126160"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Endocrinol Metab"
                        "fecha" => "1994"
                        "volumen" => "78"
                        "paginaInicial" => "800"
                        "paginaFinal" => "802"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8126160"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1210/jcem.78.3.8126160"
                      "WWW" => array:1 [
                        "link" => "10&#46;1210&#47;jc&#46;78&#46;3&#46;800"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous malformations in the face and neck&#58; radiologic diagnosis and treatment with absolute ethanol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              B Berthelsen \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              I Fogdestam \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              P Svendsen \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Radiol Diagn"
                        "fecha" => "1986"
                        "volumen" => "27"
                        "paginaInicial" => "149"
                        "paginaFinal" => "155"
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937816302022"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum ethanol levels in children and adults after ethanol embolization or sclerotherapy for vascular anomalies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              KP Mason \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              E Michna \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Zurakowski \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              BV Koka \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              PE Burrows \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiology.217.1.r00se30127"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2000"
                        "volumen" => "217"
                        "paginaInicial" => "127"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11012433"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sclerotherapy of craniofacial venous malformations&#58; complications and results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              B Berenguer \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              PE Burrows \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Zurakowski \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JB Mulliken \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg"
                        "fecha" => "1999"
                        "volumen" => "104"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10597669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1097&#47;00006534-199907000-00001"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of soft tissue injury and neuropathy after embolo&#47;sclerotherapy for congenital vascular malformation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              KB Lee \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              DI Kim \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SK Oh \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              YS Do \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              KH Kim \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              YW Kim \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jvs.2008.06.058"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Surg"
                        "fecha" => "2008"
                        "volumen" => "48"
                        "paginaInicial" => "1286"
                        "paginaFinal" => "1291"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18829241"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/j.jvs.2008.06.058"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;j&#46;jvs&#46;2008&#46;06&#46;058"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of response to percutaneous ethanol sclerotherapy &#40;PES&#41; in patients with venous malformations&#58; analysis of patient self-assessment and imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              WS Yun \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              YW Kim \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              KB Lee \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              DI Kim \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              KB Park \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              KH Kim \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jvs.2009.03.058"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Surg"
                        "fecha" => "2009"
                        "volumen" => "50"
                        "paginaInicial" => "581"
                        "paginaFinal" => "589"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19540703"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/j.jvs.2009.03.058"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;j&#46;jvs&#46;2009&#46;03&#46;058"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous malformations&#58; classification&#44; development&#44; diagnosis&#44; and interventional radiologic management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              GM Legiehn \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              MK Heran \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rcl.2008.02.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiol Clin North Am"
                        "fecha" => "2008"
                        "volumen" => "46"
                        "paginaInicial" => "545"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18707962"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/j.rcl.2008.02.008"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;j&#46;rcl&#46;2008&#46;02&#46;008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of microfoam sclerotherapy in a patient with Klippel-Trenaunay syndrome and a patent foramen ovale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              P Redodo \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Bastarrika \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Sierra \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Mart&#237;nez-Cuesta \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              J Cabrera \n
                              \t\t\t\t\t\t\t\t
                              """
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                              T Yamaki \n
                              \t\t\t\t\t\t\t\t
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                              M Nozaki \n
                              \t\t\t\t\t\t\t\t
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                              H Sakurai \n
                              \t\t\t\t\t\t\t\t
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                              M Takeuchi \n
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                              K Soejima \n
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                              T Kono \n
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Article information

ISSN: 18075932
Original language: English

DOI:10.1590/S1807-59322010000900004

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Year/Month	Html	Pdf	Total

2024 November	2	0	2
2024 October	55	23	78
2024 September	45	11	56
2024 August	47	14	61
2024 July	34	17	51
2024 June	40	9	49
2024 May	39	11	50
2024 April	39	7	46
2024 March	50	12	62
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2024 January	42	6	48
2023 December	42	32	74
2023 November	48	23	71
2023 October	38	20	58
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2023 August	35	5	40
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2023 June	14	1	15
2023 May	37	0	37
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2023 March	55	3	58
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