Clinicoradiologic predictors of sclerotherapy response in low-flow vascular malformations

Bagga, Barun; Goyal, Ankur; Das, Abanti; Bhalla, Ashu Seith; Kandasamy, Devasenathipathy; Singhal, Maneesh; Kairo, Arvind

doi:10.1016/j.jvsv.2020.03.011

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…Identification of prognostic factors is of great significance to guide individualized treatment and improve treatment response. There are studies found that welldefined margin, female gender, macrocystic type and phlebographic characteristic were variables correlated with the therapeutic effect in patients with low-flow vascular malformations or LMs [15,30,31]. At the present study, we confirmed four prognostic factors for LMs patients with sclerotherapy using polidocanol foam and pingyangmycin, and the result was partly similar to the previous studies.…”

Section: Discussionsupporting

confidence: 90%

“…However, these studies mainly report the lesion on head and neck, and include both adults and children. Recently, one study investigated clinico-radiologic predictors to predict the clinical outcome, which evaluated on the sclerotherapy response in low-flow vascular malformations [15]. At present, driven by clinical needs, there is an urgent need to establish models to predict prognostic probability and guide targeted treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

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A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children

Zou

et al. 2022

Eur J Med Res

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Purpose In this manuscript, we purposed to identify the prognostic factors for treatment of lymphatic malformations in children using polidocanol foam combined with pingyangmycin and to construct nomogram for predicting sclerotherapy response. Methods A retrospective analysis of 77 children having LMs who underwent sclerotherapy using polidocanol foam combined with pingyangmycin under ultrasound display from January 2017 to April 2020 was done. The clinical response was graded as excellent (≥ 90%), good (≥ 50%, < 90%), and poor (< 50%). More than 50% was considered as acceptable response. Prognostic factors were identified by Pearson’s Chi-square or Fisher’s exact test and multivariable logistic regression model was used to construct a nomogram to predict sclerotherapy response. The discrimination and calibration of nomogram were verified through the receiver operating characteristic cure and calibration plots. Results The mean number of treatment sessions was 3.1 (range, 1–6). Among 77 patients, 58 patients (75.3%) had excellent response to treatment (≥ 90%) and 68 patients (88.3%) had an acceptable response (≥ 50%, < 90%). Clinical disfigurement (P = 0.014), skin discoloration (P = 0.040), morphological subtype (P < 0.001) and extent of the lesion (P < 0.001) correlated with clinical response to sclerotherapy in LMs. Sclerotherapy response was predicted through nomogram constructed in this study, which shows good calibration and discrimination. Also, focal lesion and macrocystic or mixed morphological subtype lesion were seen more often in lower number of treatment sessions among the patients with excellent response. Conclusions An acceptable response to sclerotherapy using polidocanol foam combined with pingyangmycin was achieved in majority of LMs in children with extremely low complication rates. Nomogram based on the prognostic factors of sclerotherapy response for LMs in children was shown to possess an excellent performance to predict the probability of LMs sclerotherapy response.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children

Zou

et al. 2022

Eur J Med Res

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“…Identi cation of prognostic factors is of great signi cance to guide individualized treatment and improve treatment response. There are studies found that well-de ned margin, female gender, macrocystic type and phlebographic characteristic were variables corelated with the therapeutic effect in patients with low ow vascular malformations or LMs [15,30,31]. At the present study, we con rmed 4 prognostic factors for LMs patients with sclerotherapy using polidocanol foam and pingyangmycin, and the result was partly similar to the previous studies.…”

Section: Discussionsupporting

confidence: 88%

“…However, these studies mainly report the lesion on head and neck, and include both adults and children. Recently, one study investigated clinicoradiologic predictors to predict the clinical outcome, which evaluated on the sclerotherapy response in low-ow vascular malformations [15]. At present, driven by clinical needs, there is an urgent need to establish models to predict prognostic probability and guide targeted treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children

Wu¹,

Zou²,

Fu³

et al. 2022

Preprint

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Purpose In this manuscript, we purposed to identify the prognostic factors for treatment of lymphatic malformations in children using polidocanol foam combined with pingyangmycin and to construct nomogram for predicting sclerotherapy response.Methods A retrospective analysis of 77 children having LMs underwent sclerotherapy using polidocanol foam combined with pingyangmycin under ultrasound display from January 2017 to April 2020 was done. The clinical response was graded as excellent (≥90%), good (≥50%, <90%), and poor (<50%). More than 50% was considered as acceptable response. Prognostic factors were identified by Pearson’s chi-square or Fisher’s exact test and multivariable logistic regression model was used to construct a nomogram to predict sclerotherapy response. The discrimination and calibration of nomogram were verified through the receiver operating characteristic cure and calibration plots.Results The mean number of treatment sessions was 3.1 (range, 1-6). Among 77 patients, 58 patients (75.3%) had excellent response to treatment (≥90%) and 68 patients (88.3%) had an acceptable response (≥50%, <90%). Clinical disfigurement (P = 0.014), skin discoloration (P = 0.040), morphological subtype (P < 0.001) and extent of the lesion (P < 0.001) correlated with clinical response to sclerotherapy in LMs. Sclerotherapy response was predicted through nomogram constructed in this study, which shows good calibration and discrimination. Also, focal lesion and macrocystic or mixed morphological subtype lesion were seen more often in lower number of treatment sessions among the patients with excellent response.Conclusions Acceptable response to sclerotherapy using polidocanol foam combined with pingyangmycin was achieved in majority of LMs in children with extremely low complication rates. Nomogram basing on the prognostic factors of sclerotherapy response for LMs in children was showed to possess an excellent performance to predicate the probability of LMs sclerotherapy response.

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“…Other studies focused on patient satisfaction after percutaneous sclerotherapy for spongiform venous malformations, showing low complication rates after discharge with an improvement of symptoms, but often needing multiple treatment sessions, as also seen in this study [42]. A recent study by Bagga et al, focusing on "Clinicoradiologic predictors of sclerotherapy response in low-flow vascular malformations", showed similar low complication rates (11 complications in 1032 sessions) with only minor complications in patients that were treated by sclerotherapy [43].…”

Section: Discussionsupporting

confidence: 80%

Clinical Uses and Short-Term Safety Profile of Ethiodized Poppy Seed Oil Contrast Agent in the Diagnosis and Treatment of Vascular Anomalies and Tumors

et al. 2021

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Background: There is a sparsity of data on the use of ethiodized poppy seed oil (EPO) contrast agent (Lipiodol) in patients. We investigated the safety of EPO in children, adolescents, and some adults for diagnostic and therapeutic interventions. Methods: All patients who underwent procedures with EPO between 1995 and 2014 were retrospectively included. Demographic characteristics, diagnosis, dose, route of administration, preparation of EPO in combination with other agents, and complications were recorded. Results: In 1422 procedures, EPO was used for diagnostic or treatment purposes performed in 683 patients. The mean patient age was 13.4 years (range: 2 months–50 years); 58% of patients were female. Venous malformations (n = 402, 58.9%) and arteriovenous malformations (n = 60, 8.8%) were the most common diagnosis. Combined vascular anomalies included capillary–lymphatic–venous malformations, fibroadipose vascular anomalies (n = 54, 7.9%), central conducting lymphatic anomalies (n = 31, 4.5%), lymphatic malformations (n = 24, 3.5%), aneurysmal bone cysts (n = 22, 3.2%), and vascularized tumors (n = 11, 1.6%). In 1384 procedures (96%), EPO was used in various combinations with sclerosing and embolization agents, including sodium tetradecyl sulfate, ethanol, and glue. The mean volume of EPO used in interventions was 3.85 mL (range: 0.1–25 mL) per procedure with a mean patient weight of 45.9 kg (range: 3.7–122.6 kg) and a weight-adjusted dose of 0.12 mL/kg (range: 0.001–1.73 mL/kg). In 56 procedures (4%), EPO was used as a single agent for diagnostic lymphangiography. The mean volume was 4.8 mL (range: 0.3–13 mL) per procedure with a mean patient weight of 27.4 kg (range: 2.4–79.3 kg) and a weight-adjusted dose of 0.2 mL/kg (range: 0.04–0.54 mL/kg). Procedural-related complications occurred in 25 (1.8%) procedures. The 20 minor and 5 major complications were related to the primary treatment agents. None of them were directly related to EPO. No allergic reactions were noted. Conclusion: The use of an ethiodized poppy seed oil contrast agent in children, adolescents, and adults for diagnostic or therapeutic purposes is safe.

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Clinicoradiologic predictors of sclerotherapy response in low-flow vascular malformations

Cited by 9 publications

References 25 publications

A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children

A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children

A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children

Clinical Uses and Short-Term Safety Profile of Ethiodized Poppy Seed Oil Contrast Agent in the Diagnosis and Treatment of Vascular Anomalies and Tumors

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