High failure rate of umbilical vessel occlusion by ultrasound-guided injection of absolute alcohol or enbucrilate gel

The success rate for injected umbilical vascular occlusion in the published literature exceeds 85 per cent. In this study we assessed the efficacy of two forms of injected sclerosants in achieving umbilical vessel occlusion. 12 cases of attempted ultrasound-guided occlusion over a 2 1/2 year period were reviewed. These were monochorionic (MC) twins (n=6), dichorionic twins (n=3) and singletons (n=3) undergoing fetocide for severe anomalies, or im pending fetal demise. Absolute alcohol(n=6), enbucrilate gel (n=5) or both (n=1) were used in an attempt to achieve Vascular occlusion. Complete Vesse l occlusion was achieved in only a third of cases (4/12), three with absolu te alcohol and one with enbucrilate gel. In MC twins occlusion was successf ul in two of six cases. In contrast to previously published data, this larg e series, containing more cases than the total previously reported, shows c onsiderably poorer success rates for injected umbilical vascular occlusion. Injection of currently available sclerosants can no longer be recommended for umbilical vascular occlusion in human fetuses. Copyright (C) 1999 John Wiley & Sons, Ltd.