Experience of sclerotherapy and embolosclerotherapy using ethanolamine oleate for vascular malformations of the head and neck

Abstract

Sclerotherapy is effective in the treatment of vascular malformations. However, in lesions with relatively high blood flow, its effect is not always adequate. We therefore developed a three-grade classification of vascular malformations to facilitate the selection of treatments according to vascular flow. We also developed the technique of embolosclerotherapy, in which transarterial embolisation is done before sclerotherapy to control blood flow in the lesion during sclerotherapy. We now have 14 years' experience with 112 cases of vascular malformations of the head and neck treated with sclerotherapy. Results were evaluated with pretreatment and post-treatment photographs, and reduction of volume was calculated on findings from magnetic resonance imaging. Clinical improvement in 110 cases was graded as excellent in 32 (29%), good in 48 (43%), fair in 19 (17%), and poor in 11 (10%). In 84 cases, mean rate of reduction of volume was 35%. The most common complication was haemolytic haemoglobinuria (n=37, 33%). Our results suggest that this three-grade classification is useful to judge resistance to sclerotherapy and decide on treatment. Our experience indicates that ethanolamine oleate (EO), with or without arterial embolisation, was effective using our classification of vascular dynamics. We consider EO to be equivalent or superior to other sclerosants such as ethanol.

Efficacy and evaluation of safety of sclerosants for intramuscular venous malformations: Clinical and experimental studies

“…However, for our sclerotherapy using EO, our treatment was often ineffective in cases with relatively high flow lesions, so we developed a more detailed classification so that we could assess our treatment in the selection of therapeutic methods [3]. We classified vascular lesions into three categories: high, intermediate, and low flow.…”

“…These types were divided using magnetic resonance digital subtraction angiography (MRDSA) or assisted Doppler ultrasound (US), or both, as follows: the high flow indicating a lesion that shows concentrated staining early in the arterial phase and early staining of drainage veins; the intermediate flow indicating a lesion that shows dilatation of the arteries without concentrated staining that usually stains in the venous phase; while the low flow indicates a lesion without dilatation of the arterial structure, or staining, or both. According to our classification, all AVM are classified as high flow, and VM are classified as either intermediate flow or low flow [3]. For intramuscular vascular malformations, we diagnosed all lesions as VM and most were low flow.…”

“…In cases involving lesions in the distal extremities and those with severe compressive neuronal symptoms, excision may be recommended, though sclerotherapy is now preferred because it is more likely to be curative and is safer than conservative treatment or aggressive excision [3]. Excision is not recommended for extensive IMVM because of the functional results of neural or muscular damage [2,5].…”

“…However, IMVM often afflict patients with various degrees of pain and neural symptoms (including dysaesthesia), an uncomfortable oppressive sensation after hard work or exercise, and deformity [2]. Imaging such as ultrasonography (US), magnetic resonance imaging (MRI), or magnetic resonance angiography (MRA), is essential to make the correct diagnosis [3,4].…”

Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region

“…Since surgical eradication of the nidus of an AVM is rarely possible, recurrence and progression often occur. As the discipline of interventional radiology develops, embolotherapy plays an ever-increasing role in the management of AVMs [1,11,12]. Conventional mechanical occlusive embolic agents to treat AVMs were N-butyl-2-cyanoacrylate (NBCA), Polyvinyl alcohol (PVA), Gelfoam particles and fibered platinum coils with gelatin sponge particles [13,14].…”