Sclerotherapy with Pure Ethanol in Congenital Vascular Malformations Preliminary report

Huh, Seung; Kim, Dong Ik; Lee, Sun Joung; Park, Hong Suk; Do, Young Soo; Choo, In Wook; Kim, Hyun Hahk; Lee, Byung Boong

Abstract

Congenital vascular malformations (CVM) have many different clinical presentations, ranging from an asymptomatic birthmark to a life-threatening status. There has been confusion in the classification of these malformations. Two major classification systems are used at the present time: one is the Mulliken and coworkers' system that has been adopted by the International Society for the Study of Vascular Anomalies, and the other is the Hamburg classification that was declared in the 7th Meeting of the International Workshop on Vascular Malformations in Hamburg 1988. The latter is used in this article. BACKGROUND: There are many difficulties in the surgical extirpation of CVM because of their invasiveness, variability, hypervascularity, and evolutibility, especially in a diffuse infiltrating type of CVM. Thus, many endovascular ablative agents have been utilized since 1930s, but there were some handicaps, such as recanalization of previously treated vessels. Since the 1980s, Yakes has reported on much research about the effectiveness of absolute alcohol (98% ethyl alcohol) which incurs permanent vessel wall destruction. AIMS: We performed this study to evaluate the effectiveness of pure ethanol (95-99% ethyl alcohol, Samsung Medical Center, Seoul, Korea) in the treatment of inoperable CVM, to identify the complications that occur and to establish the method of endovascular ablative therapy.
MATERIALS AND METHODS
From August 1996 through October 1997, we applied 37 sessions of sclerotherapy using direct puncture technique with pure ethanol to 19 patients with the extratruncular, diffuse infiltrating type of CVM (11 predominantly venous, 8 predominantly arteriovenous shunting)among 250 CVM patients registered at the CVM Clinic of Vascular Center at Samsung Medical Center.
RESULTS
Angiographically, the results were excellent in 33 (89%) and good in 3 (9%) sessions. Only one (3%) session failed due to extravasation of the contrast media. The mean follow-up period was only 6 months; 17 (89%) patients were symptomatically improved. Some complications, such as ischemic bullae, deep vein thrombosis, and hematuria, developed, but those patients were recovered without any problem.
CONCLUSIONS
The short-term results of pure ethanol sclerotherapy for the diffuse infiltrating type of CVM were good. With more clinical experience, this new treatment modality will be more effective. Further investigations are needed to solve the some complications.