Gross Hemoglobinuria and Oliguria Are Common Transient Complications of Sclerotherapy for Venous Malformations: Review of 475 Procedures

Pons, R; Burrows, Patricia E.; Landrigan‐Ossar, Mary; Trenor, Cameron C.; Alomari, Ahmad I.

doi:10.2214/ajr.11.8285

Cited by 24 publications

(16 citation statements)

References 13 publications

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“…All patients recovered without any further complications with proper fluid management. Hemoglobinuria risk was correlated with the volume of sclerosant (adjusted to patient's weight) and was higher for lower extremity and multiple locations 18 . It is unclear why the individuals in our study developed less hemoglobinuria but may be due to procedural differences.…”

Section: Discussionmentioning

confidence: 72%

Retrospective study of hematologic complications in patients with slow‐flow vascular malformations undergoing sclerotherapy

Ricci

Chute

Hammill

et al. 2020

Pediatric Blood & Cancer

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Background Slow‐flow vascular malformations (SFVM) are associated with localized intravascular coagulopathy (LIC), which is characterized by elevated D‐dimer and, when severe, hypofibrinogenemia. LIC results in intralesional clotting and hemorrhage and increases risk for significant thrombotic and bleeding complications. Sclerotherapy has been a suggested potential trigger for LIC worsening to disseminated intravascular coagulopathy. Hematologic complications of sclerotherapy in SFVM, along with low‐molecular‐weight heparin (LMWH) used to prevent worsening LIC, are largely unstudied. Procedure Medical records of patients with SFVM and LIC who underwent sclerotherapy at Cincinnati Children's Hospital Medical Center from July 2008 to December 2016 were reviewed for periprocedural hematologic complications. LMWH dose, frequency, and course length were evaluated. Results Fifty‐nine patients with SFVM and LIC underwent 281 sclerotherapy procedures, of which 86% were in children. Eighty‐five percent of patients received periprocedural LMWH, although at various doses and course lengths. No thrombotic complications occurred in children. One adult on LMWH developed pulmonary emboli after sclerotherapy. No major bleeding complications occurred postoperatively. In four patients, fibrinogen dropped below 100 mg/dL post‐sclerotherapy, requiring cryoprecipitate. One patient required packed red blood cell (RBC) transfusion for sclerotherapy‐induced hemolysis. No intraoperative bleeding or thrombotic events occurred. Conclusion LMWH use, at subtherapeutic dosing, was common in this patient population and did not appear to increase risk of significant bleeding before, during, or after sclerotherapy. In children with SFVM, bleeding and thrombotic complications after sclerotherapy appear rare. Although safe, prospective studies are needed to evaluate the efficacy of LMWH to prevent worsening coagulopathy with procedures.

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Section: Discussionmentioning

confidence: 72%

Retrospective study of hematologic complications in patients with slow‐flow vascular malformations undergoing sclerotherapy

Ricci

Chute

Hammill

et al. 2020

Pediatric Blood & Cancer

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“…Studies 14 have shown that transient hemoglobinuria is a common complications seen after sclerotherapy. Proposed mechanism is that the controlled delivery of a toxic agent (sclerosant) damages the endothelial lining of the malformation and but also to nonmalformation endothelial lining.…”

Section: Importance Of Recognizing Localized Intravascular Coagulationmentioning

confidence: 99%

Venous Malformation and Localized Intravascular Coagulopathy in Children

et al. 2016

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Localized intravascular coagulopathy (LIC) has been described in adults with venous malformation (VM) but rarely reported in children. This study aims to determine the prevalence of LIC in children with VM and associated risk factors. Patients younger than 18 years with VM from 2010 to 2014 were reviewed. Diagnosis was confirmed by Doppler ultrasound and/or magnetic resonance imaging. Demographics data and VM characteristics including volume, site, extension, painful symptoms, and palpable phleboliths were studied. Plasma D-dimer level of greater than 500 ng/mL was considered as abnormal. Total 24 children were included, of whom 8 were boys. Median age of presentation was 9 months (range: 0-12 years). Head-and-neck VM occurred in 17 (70.8%) patients and 3 (12.5%) had multifocal lesions. Seven (29.2%) patients had VM volume greater than 10 mL. Five (20.8%) patients had painful symptoms. Palpable phleboliths were found in two patients. Plasma D-dimer was raised in eight cases (33.3%). One patient with Klippel-Trenaunay syndrome (KTS) had D-dimer level of 5,000 ng/mL. Raised D-dimer was found in 23.5% of small VM (volume < 10 mL) and 57.1% of large VM ( = 0.167). D-dimer was significantly raised in multifocal VM ( = 0.028) and showed increasing trend in lesions with palpable phleboliths ( = 0.101). All patients had sclerotherapy performed with indications (cosmesis 41.7%, enlarging lesion 29.2%, pain 20.8%, bleeding 8.3%). Perioperatively, bolus intravenous fluid and mannitol were given to selected patients. All patients had VM volume reduction after sclerotherapy. There were no major thromboembolic complications. LIC with raised D-dimer level occurred in one-third of pediatric VM. It was more common in large, multifocal VM and in those with palpable phleboliths or KTS.

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“…As these lesions will grow and become more complex over time [16,17], it is increasingly common for treatment to start in childhood. Sclerosing agents are described in Table 1 [18][19][20][21][22][23].…”

Section: Sclerotherapy Of Vascular and Lymphatic Malformationsmentioning

confidence: 99%

“…treated with hydration and urine alkalinization [18]. Contrast reactions are a constant threat; their management is similar to that for anaphylaxis [25].…”

Section: Key Pointsmentioning

confidence: 99%