Percutaneous Sclerotherapy of Venous Malformations of the Hand: A Multicenter Analysis

Abstract

Purpose To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand. Materials and Methods A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig’s classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments. Results The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig’s classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients. Conclusion Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients. Level of Evidence Level 4, Retrospective study.

Palmar Venous Malformation: A Case Report of a Rare Occurrence and a Treatment Algorithm

“… 18 A meta-analysis by Schmidt et al, however, concluded that sclerotherapy is both safe and effective in the treatment of these lesions, even when previous attempts have been made. 19 Guevara et al reported their overall complication rate following sclerotherapy of venous malformations of the hand and distal forearm in 17 patients who underwent a total of 40 procedures. They only noted two skin complications that had a complete resolution.…”

Interventional Treatment Options in Children with Extracranial Vascular Malformations

“…46 Thus, polidocanol is a mild sclerotherapy option, but may show similarly good treatment results after repeated sessions. 47,48 Bleomycin, a cytostatic agent belonging to the class of antibiotics, differs in its underlying sclerosing mechanism from the previously mentioned sclerosants. As dismantling the solid stroma of vascular structures, 49 it seems to be most efficient in comparatively spongiform VMs providing large stromal components.…”

“…46 Thus, polidocanol is a mild sclerotherapy option, but may show similarly good treatment results after repeated sessions. 47 48…”

Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations—Proof of Concept Study for Prediction of Clinical Outcome

“…Venous malformations (VM) are slow-flow vascular malformations according to the ISSVA (International Society for the Study of Vascular Anomalies) classification, with a prevalence of up to 1% in the overall population [ 1 , 2 , 3 ]. VM are congenital lesions consisting of dysplastic and dilated veins due to a disturbed vasculogenesis.…”

“…These agents harm dysplastic endothelial cells of VMs, causing intralesional thrombosis, inflammation, and scarring. Percutaneous sclerotherapy has proven to be effective even in challenging anatomic regions accompanied by a low risk profile [ 2 ]. However, many patients require several sessions of percutaneous sclerotherapy before improvement of clinical symptoms may be recognized.…”