Symptomatic vascular malformations: ethanol embolotherapy.

Yakes, Wayne F.; Haas, David; Parker, Steve H.; Gibson, M D; Hopper, Kenneth D.; Mulligan, Janet; Pevsner, Paul H.; Johns, J C; Carter, T E

doi:10.1148/radiology.170.3.2916057

Cited by 240 publications

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“…Despite a substantial recurrence rate with increased symptoms after less aggressive procedures, it is difficult to justify function-altering wide resections for these benign tumors. Sclerotherapy has been recognized for decades as a less morbid treatment option, with ethanol being the most common sclerosant [14,16]. However, most reports have focused on superficial lesions and their cosmetic consequences [6,8,14], with few dealing exclusively with deep musculoskeletal lesions [7,13] and the effectiveness of sclerotherapy in pain relief [7,9].…”

Section: Discussionmentioning

confidence: 99%

“…Superficial lesions are at risk for skin necrosis [2]. Temporary postsclerotherapy swelling is normal [14,16], but persistent swelling may indicate deep vein thrombosis in the normal circulation. Rare systemic complications occur if sclerosant, particularly ethanol, leaks into arterial circulation and can include arterial thrombosis, hypotension, or even death [9,10,14].…”

Section: Discussionmentioning

confidence: 99%

“…Rare systemic complications occur if sclerosant, particularly ethanol, leaks into arterial circulation and can include arterial thrombosis, hypotension, or even death [9,10,14]. This is easily avoided with available anesthesia support, serial small volume injections, and preprocedural observation of the lesion for systemic anastomoses [7,16]. A technique has been developed to further reduce risk by using a second needle to drain the ethanol from the hemangioma [10].…”

Section: Discussionmentioning

confidence: 99%

“…The number of sclerosing agents available for this procedure and sites for its application has expanded during the years. Ethanol remains a popular choice because of its high potency, availability, and ease of administration [16]. The assistance of anesthesia and ultrasound allow ethanol to be used safely even for deep musculoskeletal lesions.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, reports generally comprise deep and superficial lesions, often include those of the face and skull and intrapelvic lesions, or investigate the use of alternate sclerosing agents [6,8,9,[14][15][16][17]. There also is a paucity of literature concerning the utility of sclerotherapy as an analgesic treatment modality in these lesions, as numerous reports address cosmetic issues, spinal cord compression, or, in the case of massive lesions, cardiovascular compromise [6,8,16,17].…”

Section: Introductionmentioning

confidence: 99%

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Ethanol Sclerotherapy Reduces Pain in Symptomatic Musculoskeletal Hemangiomas

Crawford

Slotcavage

King

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Hemangiomas, benign vascular lesions, require intervention if causing pain or functional limitations. Functional deficits are common after excision, favoring minimally invasive treatments. To determine whether ethanol sclerotherapy reduces pain and lesion size and to assess complications in symptomatic musculoskeletal hemangiomas, we retrospectively reviewed 19 patients (six males, 13 females; mean age, 34 years) meeting criteria of confirmed hemangioma, treatment with ethanol sclerotherapy, and minimum of 6 weeks of followup. Fourteen were primary lesions and five were recurrent; all were painful. Thirty-eight sclerotherapy procedures were performed, with each patient undergoing a maximum of three procedures. Mean followup was 24 months (range, 2-95 months). Four patients reported full pain relief, 11 had partial relief, and four had no relief. With recurrent lesions, one patient had full pain relief, one had partial relief, and three had no relief. For patients with lesions larger than 5 cm, two had full relief, six had partial relief, and three had no relief. Lesion shrinkage occurred in 12 patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ethanol Sclerotherapy Reduces Pain in Symptomatic Musculoskeletal Hemangiomas

Crawford

Slotcavage

King

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Laser Surgical Planning With Magnetic Resonance Imaging–Based 3-Dimensional Reconstructions for Intralesional Nd:YAG Laser Therapy of a Venous Malformation of the Neck

Glaessl

Schreyer²,

Wimmershoff³

et al. 2001

Arch Dermatol

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Arteriovenous Malformation Treated With Embolization and Laser Therapy

Ashinoff¹

1991

Arch Dermatol

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In March 1988, a 5-month-old baby girl was examined for a bright-red macular discoloration involving the lower two thirds of the left ear, extending down to the retroauricular and preauricular skin (Fig 1). Her left ear was markedly hypertrophic, compared with her right ear, and was warm to the touch. A bruit and a thrill were heard. The child's physical and cognitive development was otherwise normal. The patient was evaluated at age 8 months and again at age 1 year. At this time, the patient underwent magnetic resonance imaging and angiography. The arteriovenous malformation (AVM) had arteriovenous fistulization supplied primarily by the posterior and anterior auricular arteries (Fig 2, A). At the age of 16 months, the patient underwent selective embolization with cyanoacrylate isobutyl. The embolization was successful in devascularizing approximately 95% of the malformation (Fig 2, B). Following this procedure, the size of the left ear decreased, and the color of that ear changed from bright red to reddish purple, which suggested thrombosis of the venous end of the fistula.At age 18 months, test sites received therapy with a flashlamp-pumped pulsed dye laser (SPTL-1, Candela Corp, Wayland, Wash), with rhodamine in methanol as the dye. The following parameters were used: wavelength, 585 nm; pulse duration, 450 ¿¿second; circular spot size, 5 mm; and energy level, 5.75 to 6.5 cm2. Six weeks later, under general anesthesia the patient had the entire 8 X 5-cm area over the left ear, cheek, and neck treated with the pulsed dye laser. The cheek, neck, and most of the ear received 5.75 J/cm2; 7.5 J/cm2 was used on a small area of the left concha to induce some shrinkage of the slightly enlarged area. This proce¬ dure was repeated 3 months later with marked lightening. Some thicker areas on the left ear remained, and these were treated with an argon laser (Coherent Medical, Palo Alto, Calif) (2 W; pulse duration, 0.1 second), with excellent results and no evidence of scarring.The patient is currently undergoing pulsed dye laser treatment for the residual cutaneous components of her AVM. The size of the left ear has diminished but is still slightly larger than the right ear (Fig 3). Her hair can be used to camouflage the discrepancy, or she may elect to have plastic surgery at a later date. THERAPEUTIC CHALLENGEDifferentiation between various types of AVM to select those that can be successfully treated with transcatheter embolization is a dilemma in the very young child. Man¬ agement of an AVM with cutaneous capillary components requires evaluation by multiple specialties. COMMENT Hemangiomas and AVMs are part of a large group of congenital vascular lesions. It is important to differentiate between them, because AVMs can often be treated success¬ fully with transcatheter embolization.13 Planning therapy, however, requires an understanding of the clinical behav¬ ior and natural history of different vascular neoplasms. An accurate medical history, physical examination, and, when called for, continued examination over tim...

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Symptomatic vascular malformations: ethanol embolotherapy.

Cited by 240 publications

References 0 publications

Ethanol Sclerotherapy Reduces Pain in Symptomatic Musculoskeletal Hemangiomas

Ethanol Sclerotherapy Reduces Pain in Symptomatic Musculoskeletal Hemangiomas

Laser Surgical Planning With Magnetic Resonance Imaging–Based 3-Dimensional Reconstructions for Intralesional Nd:YAG Laser Therapy of a Venous Malformation of the Neck

Arteriovenous Malformation Treated With Embolization and Laser Therapy

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