Multicentered analysis of percutaneous sclerotherapies in venous malformations of the face

Abstract

ObjectivesTo evaluate the safety and outcome of image-guided sclerotherapy for treating venous malformations (VMs) of the face.Materials and methodsA multicenter cohort of 68 patients with VMs primarily affecting the face was retrospectively investigated. In total, 142 image-guided sclerotherapies were performed using gelified ethanol and/or polidocanol. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Sub-analyses of complication rates depending on type and injected volume of the sclerosant as well as of pediatric versus adult patient groups were conducted.ResultsMean number of procedures per patient was 2.1 (±1.7) and mean follow-up consisted of 8.7 months (±6.8 months). Clinical response (n = 58) revealed a partial relief of symptoms in 70.7% (41/58), 13/58 patients (22.4%) presented symptom-free while only 4/58 patients (6.9%) reported no improvement. Post-treatment imaging (n = 52) revealed an overall objective response rate of 86.5% (45/52). The total complication rate was 10.6% (15/142) including 4.2% (7/142) major complications, mostly (14/15, 93.3%) resolved by conservative means. In one case, a mild facial palsy persisted over time. The complication rate in the gelified ethanol subgroup was significantly higher compared to polidocanol and to the combination of both sclerosants (23.5 vs. 6.0 vs. 8.3%, p = 0.01). No significant differences in complications between the pediatric and the adult subgroup were observed (12.1 vs. 9.2%, p = 0.57). Clinical response did not correlate with lesion size reduction on magnetic resonance imaging (MRI).ConclusionImage-guided sclerotherapy is effective for treating VMs of the face. Clinical response is not necessarily associated with size reduction on imaging. Despite the complex anatomy of this location, the procedures are safe for both adults and children.

Ultrasonography-guided radiofrequency ablation of vascular malformations—The moving shot technique

“…For venous malformations, besides conservative management, invasive therapy is indicated in symptomatic VMs to reduce symptoms such as pain, hemorrhage, and impairment of neighboring structures. For VMs percutaneous sclerotherapy is the first-choice invasive treatment method and can be combined with laser therapy or surgical procedures (20,21). However, evidence is low and the choice for the invasive method remains a shared decision between the patient and a multidisciplinary team of specialists (22,23).…”

“…Overall, eight patients were included; five (62.5%) were male, and three (37.5%) were female. Median age was 22 years [total range, 11-56; interquartile range (IQR), [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. One patient had an arteriovenous malformation (classified as Schobinger II and Cho IIIb), four had venous malformations (2x Puig type I, 1x type II and 1x type III), and one each had a mixed venouslymphatic malformation, a glomuvenous malformation and a FAVA (fibroadipose vascular anomaly).…”

Congenital Vascular Malformations in Children: From Historical Perspective to a Multidisciplinary Approach in the Modern Era—A Comprehensive Review

“…Studies on treatment outcomes of sclerotherapy/embolization often focus on a specific CVM subtype, a specific anatomical location, or a specific agent, and the definition of a successful treatment outcome varies, all of which limits comparability. In recent studies on pediatric patients, a complete response was reported in 11-89% of the patients and improvement in 57-100% [34,48,49,51,54,69,70]. In LMs, bleomycin seems to be the most effective agent, and macrocystic lesions often showed a better response than microcystic and/or mixed lesions [49,53,70].…”

“…The technique consists of injecting chemical agents into the CVM with the aim of thrombosing and obliterating the vessels and thereby inactivating the malformation. Initially reserved for patients deemed inoperable, sclerotherapy and embolization have emerged as the treatment of choice in many cases, offering advantages over surgical resection [47][48][49][50]. Various chemicals can be used, such as ethanol, coils, glues, Onyx (ethylene-vinyl alcohol copolymer), bleomycin, polidocanol (aethoxysclerol), doxycycline, and many more [49,[51][52][53][54][55][56][57][58].…”

“…In AVMs, the success rate of embolization was influenced by the angioarchitecture of the nidus [54]. Complication rates varied from 6-25% on the procedural level and from 10-54% on the patient level in recent studies [34,48,49,51,54,69,70], with historical data reporting complication rates up to 82% on the procedural level and 72% on the patient level [50,59,71]. Complications frequently reported include skin necrosis, infections, and (mostly temporary) nerve complications.…”