Neurointervention.  2019 Mar;14(1):53-60. 10.5469/neuroint.2019.00024.

Efficacy of Percutaneous Sclerotherapy in Low Flow Venous Malformations - A Single Center Series

• Ahmad S

• KMID: 2446782
• DOI: http://doi.org/10.5469/neuroint.2019.00024

Abstract

PURPOSE
We analyzed results of percutaneous sclerotherapy for venous malformations (VMs) in head, neck and extremities.
MATERIALS AND METHODS
Thirty-five patients with head and neck and extremities VM treated by sclerotherapy with bleomycin and sodium tetradecyl sulphate (STS) were retrospectively reviewed. A pre-treatment magnetic resonance imaging was done for all patients to diagnose the lesion. Each lesion received 1 to 11 sessions (average, 2.7; standard deviation [SD], 2.03). We evaluated percentage reduction in swelling size and a Likert scale review of subjective feelings of the patients.
RESULTS
Sixteen had a complete obliteration; by sclerotherapy alone (n=13) and surgery after a 75% reduction (n=3). Ten patients had a significant reduction up to 75% and three patients by 50%. Four had a minimal decrease with reduction of 25% or less. Follow-up duration of the patients varied from a minimum of 6 months up to 3 years (average, 15.7 months; SD, 7.8 months). Of all patients, three refused further treatment and were lost to follow-up, while another two were referred to a dermatologist. Thirteen patients reported feeling excellent after the sessions. Eight patients claimed to feel slightly better compared to before the sessions started. Only three patients complained of feeling the same before and after the sessions. None of the patients still in follow-up have reported a recurrence of a lesion thus far.
CONCLUSION
Sclerotherapy using bleomycin and STS as sclerosants is a safe and effective primary treatment for VMs in the head and neck as well as in extremities.

Keyword

Sclerotherapy; Vascular malformations; Magnetic resonance imaging

MeSH Terms

Bleomycin
Extremities
Follow-Up Studies
Head
Humans
Lost to Follow-Up
Magnetic Resonance Imaging
Neck
Recurrence
Retrospective Studies
Sclerosing Solutions
Sclerotherapy*
Sodium
Vascular Malformations
Bleomycin
Sclerosing Solutions
Sodium

Figure

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  Fig. 1. This is a flow diagram of the process followed in the study. OPD, out patient department; MRI, magnetic resonance imaging; DSA, digital subtraction angiography.

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  Fig. 2. Twenty-three-year-old female with swelling in the face and lip. Extra-oral view of venous malformation of the oral cavity before treatment (A) after 10 sessions (B). T2-weighted axial magnetic resonance image of an extensive venous malformation of the oral cavity brfore (C) and (D) after treatment.

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  Fig. 3. Sclerotherapy of venous malformation in the forearm (A). T2-weighted magnetic resonance image shows venous malformation with high signal intensities and foci of low signals corresponding to phleboliths (B). Percutaneous phlebography of venous malformation shows irregular venous vascular space (C). Disappearance of the swelling in the left forearm after sodium tetradecyl sulphate (D).

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