Percutaneous Lauromacrogol Foam Sclerotherapy for the Treatment of Acute Airway Compression Caused by Lymphatic Malformations in Infants

Abstract

Management of LMs still remains a challenge especially for those suffering from complications such as acute airway compression. In this study, we retrospectively evaluated the efficacy and safety of percutaneous lauromacrogol foam sclerotherapy for the patients with acute airway compression caused by lymphatic malformations (LMs) in infants. Five cases of infants with acute airway compression caused by LMs were treated with lauromacrogol foam sclerotherapy in the radiology department from February 2013 to August 2015 at Wuhan Medical and Healthcare Center for Women and Children, China. By CT examination and the DSA imaging, LMs were diagnosed and progressed cervical and sublingual LMs combined with hemorrhages were observed and suppression of the trachea was noticed as well, resulting in the difficulty with breathing and feeding. For all the patients, we extracted most cyst liquid from the LMs to reduce the surface tension and alleviate the respiratory pressure symptoms under the guidance of ultrasound. Subsequently, the lauromacrogol foam was injected percutaneously into the cyst of LMs. The dose of the agent was determined according to the size of the LMs, which was 3-8 ml in our study. After treatment, autonomous respiration and independent eating were observed. When the procedures were completed after 16 cycles, the cyst cavity became atrophic and then nearly vanished. During the follow-up period (a minimum of three months and a maximum of two years), 4 patients were clinically proved to be cured and one patient was significantly improved. There was no recurrence, serious complications, or adverse reactions. Our study demonstrated that percutaneous sclerotherapy combined with lauromacrogol foam is a safe, effective therapy for acute airway compression caused by LMs, especially giving a good cosmetic result.

Lymphatic malformations adjacent to the airway in neonates: Risk factors for outcome

“…Other studies showed that sclerotherapy was more effective in macrocystic LMs compared to microcystic or mixed LMs [ 15 , 37 ]. This could explain the good clinical outcomes in the case series of Wang et al, where all five patients had macrocystic LMs [38] . Although in the present study one patient with a microcystic LM started experimental systemic therapy early, no significant differences were found, probably due to the small patient population and the large subset of mixed LMs in this study.…”

Sclerotherapy with polidocanol microfoam in head and neck venous and lymphatic malformations

“…In a recent manuscript, Hou et al 16 described their experience of POL sclerotherapy in 47 patients with VMs and reported a poor outcome for only 2/47 patients. POL sclerotherapy of LMs has been reported in only a few series and rarely in head neck lesions 14 , 17 , 24 . Yamaki et al 17 described a series of 32 LMs treated with polidocanol sclerotherapy.…”

“…Polidocanol (hydroxy-polyethoxy-dodecane -POL), a synthetic long-chain fatty alcohol, is a liquid surfactant with endothelial cytolytic properties and has mainly been used for venous malformations. Polidocanol injection is painless, does not induce necrosis if injected intradermally and rarely produces allergic or inflammatory reactions [13][14][15][16][17] . Recently, it has also been proposed for lymphatic ones even though it has been investigated in only a limited number of studies based on small samples, including several sites and not focused only on head and neck cases 14,17,18 .…”

“…Polidocanol injection is painless, does not induce necrosis if injected intradermally and rarely produces allergic or inflammatory reactions [13][14][15][16][17] . Recently, it has also been proposed for lymphatic ones even though it has been investigated in only a limited number of studies based on small samples, including several sites and not focused only on head and neck cases 14,17,18 . Herein, we report our protocol for head and neck lesions describing our endoscopic and percutaneous approaches that are performed in close cooperation between an interventional radiologist and ENT surgeon.…”

“…Polidocanol injection is painless, does not induce necrosis if injected intradermally and rarely produces allergic or inflammatory reactions 13-17 . Recently, it has also been proposed for lymphatic ones even though it has been investigated in only a limited number of studies based on small samples, including several sites and not focused only on head and neck cases 14 , 17 , 18 .…”