Direct Percutaneous Alcohol Sclerotherapy for Venous Malformations of Head and Neck Region without Fluoroscopic Guidance: Technical Consideration and Outcome

Abstract

PurposeAlcohol is not used directly to the vascular lesion without mixing with the contrast agent because alcohol itself cannot be seen on the fluoroscopy. Since we have used alcohol for the venous malformations in the head and neck area, we realized that alcohol can be safely and effectively used without using fluoroscopy. We present the method of direct sclerotherapy using absolute alcohol without using fluoroscopy.Materials and MethodsAfter obtaining and carefully analyzing direct puncture venogram, we used this technique in 22 patients who underwent alcohol sclerotherapy. Because fluoroscopy was not used during alcohol injection, the angiotable can be placed outside of C-arm so that alcohol was comfortably injected without any obstacle around the patients. Venogram can also be obtained between the injections to detect whether there is any dangerous venous outflow drainage such as the superior ophthalmic vein to the cavernous sinus. To control the venous outflow, local compression to the draining vein was applied. The result and complication such as skin necrosis, infection, and nerve injury were evaluated during mean follow-up period of 13 months (range, 1-63 months).ResultsThe frequency of sclerotherapy was one in 16 and 2-5 in 6 patients. The volume of alcohol used per treatment session ranged from 2 to 18 mL (mean, 8.5 mL). There was the minimum change in 1 (4.5%), moderately decreased lesion in 12 (54.5%), and markedly decreased lesion in 9 (41%) patients. The patients did not reveal any complications during 12.9 months follow-up period.ConclusionDirect puncture alcohol sclerotherapy without using fluoroscopy can be a safe and effective technique for treating venous malformation of the head and neck areas. In addition, the procedure can be performed in the comfortable position because biplane fluoroscopy would not be necessary.

Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis

“…Alcohol is generally best used for deeper VMs due to the risk of skin necrosis from extravasation. 4,28,29 Superficial VMs are likely best treated with milder agents such as bleomycin or STS. 5,26,28,29 The results from our study compare favorably to other modalities of treatment including medical therapy, surgical resection and laser therapy.…”

Ethanol sclerotherapy for venous malformation

“…Complications that occurred in our series included necrosis of the lip requiring surgery, transient Horner's syndrome, finger paraesthesia and reduced wrist supination, transient weakness or sensory dysfunction, skin blistering and tongue ulceration. These are recognized complications of ES which also include deep vein thrombosis, pulmonary embolism, systemic alcohol contamination and cardiac arrest if the dose of 1 mL/kg per session is exceeded …”

Evidence-Based Management of Vascular Malformations

“…The evidence supporting the use of sclerotherapy as a single agent for VMs is supported by a level III, systematic review 48 ; multiple level IV, prospective case series 83,84 ; and multiple level IV, retrospective case series. 55,77,[85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102][103] The literature supports the use of numerous sclerotic agents for VMs, with the most widely reported ones being alcohol-based agents, sodium tetradecyl sulfate foam, ethanolamine oleate, and bleomycin.…”