Alcohol Embolotherapy of Vascular Malformations

Surgical treatment of hemangiomas and vascular malformations in functional areas

“…Bulk reduction by means of sclero therapy (alcohol, Ethibloc) or laser photocoagulation is often utilized in the head and neck region [4,5,15,20], Smaller, localized VeMs may better be excised. In our departments, cystic LMs are preferably treated surgically, although sclerosing therapies (Ethibloc, OK432) are also recommended by other authors [2,12].…”

“…Ligation of the main vascular pedicle prohibits emboliza tion in case of recurrence, so this is not recommended. Combination therapy is essential [7,11,13]; in large resections it may be necessary to reconstruct the defect that has been created with a free, revascularized tissue transfer [11,20,21].…”

Treatment guideline for hemangiomas and vascular malformations of the head and neck

“…Ethanol is recognized as the most effective sclerosing agent in the treatment of venous malformation; it has an effective rate of 100%, 24 has a low recurrence rate, and is nontoxic to the liver and kidneys within the safety amount. Digital subtraction angiography (DSA)-guided percutaneous ethanol injection is a recent advance in the treatment of venous malformation, which is suitable for grade 2 and 3 (diameter greater than 5 cm) facial and cervical venous malformations, according to the MRI classification of Goyal et al 25 ; grade 2A, well defined, with a diameter greater than 5 cm; grade 2B, ill defined, less than or equal to 5 cm in diameter; grade 3, ill defined, greater than 5 cm in diameter.…”

“…24 For infiltrative AVMs, it is suggested to use a mixture of ethanol and contrast at a ratio of 1:1 for embolization, whereas nidus and arteriovenous fistula require absolute alcohol for embolization. 34 If AVMs of the soft tissues affect important anatomic structures with severe disfigurements, the most effective treatment is preoperative embolization and radical resection.…”

“…The volume of ethanol is 2/3 to 3/4 of the contrast agent, and the maximum volume is 1 mL/kg body weight. 24 Ethanol is then administrated quickly into the lesions; the blood pressure and heart rate of the patients are monitored simultaneously. If the venous drainage is fast, the main reflux veins should be compressed during injection.…”