Fluoroscopy-guided foam sclerotherapy with sodium morrhuate for peripheral venous malformations: Preliminary experience

Abstract

Fluoroscopic guidance could have great promise in foam sclerotherapy of peripheral venous malformations, although larger studies are necessary to determine the advantages of this technique over other sclerotherapeutic methods.

A New Method for Using Radiopaque Sclerosing Foam to Treat Venous Malformations

“…21 However, few side effects were observed with the combination of POL and iopromide according to Li's studies. 13,16 The half-life of POL-only foams was 111.5 seconds in this study and was almost equal to the results of the research by Rao and Goldman (110 seconds). 18 The foam stability varied with different ratios of iopromide.…”

“…In addition to duplex ultrasound, fluoroscopy and DSA are new imaging tools for tracking foam flow in vessels. Based on radiological guidance, Li 13,16 proposed a filling defects technique for visibly treating VMs. This 2-step technique is complicated and time consuming in terms of the therapeutic process and is not always suitable for complex VMs in the head and neck.…”

“…5,[11][12][13][14][15] The ultrasonography is limited to detecting the venous outflow and extravasation of sclerosing agents and requires special skills of operators. 16 However, foam flows can be traced with a "filling defects" technique under DSA. This procedure occurs by first injecting the contrast agent (usually iopromide) into the lesion to display the malformed blood vessels and then infusing the sclerosant to replace the initial contrast agent.…”

“…This procedure occurs by first injecting the contrast agent (usually iopromide) into the lesion to display the malformed blood vessels and then infusing the sclerosant to replace the initial contrast agent. 13,16 This 2-step filling defects technique is relatively complicated and may cause the percutaneous puncture needle displacement from the correct lesion position, especially in complicated anatomical regions such as the head and neck (which account for 40% of VMs). 17 Additionally, a small amount of contrast agent probably remains in large lesions, although the sclerosing foam has already arrived distal venous drainage.…”

Venous malformation: update on aetiopathogenesis, diagnosis and management

“…However, strokes, headaches, scotoma, and other neurological complications have been reported in 2% of patients, confirming the potential risk of gas embolism. 71, 72 Cabrera and collaborators used carbon dioxide and reported a better solubility of the gas with the detergent solution, a better stability of the injected product, and less cardiovascular and neurologic complications due to gas embolism. 73 The use of this microfoam agent has not been reported in other centers.…”