Treatment of venous malformations with tumescent-assisted sclero-embolic and ablative lasers (SEALs): Safe and effective long-term outcomes

Abstract

Background Perivascular infiltration of tumescent anaesthesia (TA) is an essential element of endovenous thermal ablative procedures employed to treat superficial venous disease. In addition to anaesthesia, TA is administered to achieve vessel wall approximation and to protect surrounding structures from thermal damage. However, its role in the treatment of venous malformations (VMs) has not been established. Objectives To assess the safety and efficacy of tumescent-assisted thermal and chemical ablative methods in the treatment of VMs. Methods Adult and paediatric patients presenting with VMs were treated using a combination of endovenous laser ablation, foam embolo-sclerotherapy and liquid embolisation using n-BCA. All procedures were ultrasound-guided. Treatment outcomes were assessed in early and late follow-ups. To assess the efficacy of TA in achieving vessel wall approximation, cross-sectional lesional diameters were measured by ultrasound, before and after the administration of TA during endovenous procedures. Results In a 12 month period, 22 patients recruited in the study presented with 27 VMs which included 23 extra-truncular lesions (16 subcutaneous and seven intramuscular) and four truncular anomalies. On average the subcutaneous lesions measured 5.5 mm (1.9–24.5 mm) in diameter, intramuscular lesions measured 9.2 mm (5.9–15.1 mm) and truncular anomalies measured 4.9 mm (1.2–12 mm) in diameter. Perivascular infiltration of TA resulted in a significant reduction in vessel calibre (90% reduction on average). Intramuscular VMs were less compressible with TA (69.2% reduction) compared to subcutaneous lesions (98% reduction). Truncular anomalies such as the embryonic marginal vein achieved complete approximation (100% reduction). Procedures were safely tolerated with no major complications such as thromboembolism, stroke, nerve damage or tissue necrosis. Most patients had significant clinical as well as ultrasonographic improvement. Conclusion Tumescent-assisted endovenous laser ablation and foam sclerotherapy provides safe and effective outcomes in patients with a variety of VMs.

Myopericytomatosis: A rare entity mimicking other vascular tumours and malformations

“…UGS was performed with the assistance of tumenscent anaesthesia which renders better haemostasis due to the effect of adrenaline in the anaesthetic solution. 7 We also used UGS to treat the diffuse tumours within the subcutaneous tissue where multiple excisions would have been required to remove the tumour. Our patient underwent three procedures spanning across 2 months.…”

“…We performed UGS on the target lesion and its draining veins to achieve haemostasis. UGS was performed with the assistance of tumenscent anaesthesia which renders better haemostasis due to the effect of adrenaline in the anaesthetic solution 7 …”

Endoscopic Resection for Vascular Anomalies in Children

“…Nonsurgical management includes ethanol embolization, 14,15 sclerotherapy, 16 oral target therapy (sirolimus and alpelisib), 17 endovenous radiofrequency ablation, [18][19][20] and laser therapy. 21 In patients with vascular malformations and associated severe bulk or overgrowth or recurrent pain from SVT, surgery is usually required. For these cases, we have performed traditional resection over many years.…”

“…Interventional radiologic therapy and surgery are usually essential treatments and can be combined. Nonsurgical management includes ethanol embolization, 14,15 sclerotherapy, 16 oral target therapy (sirolimus and alpelisib), 17 endovenous radiofrequency ablation, 18–20 and laser therapy 21 . In patients with vascular malformations and associated severe bulk or overgrowth or recurrent pain from SVT, surgery is usually required.…”

Therapeutic evaluation and analysis of complications of ethanol sclerotherapy for intramuscular vascular malformations: a single-center retrospective study

“…However, there are few clinical studies related to the use of ethanol gel, and additional research is required to confirm its effectiveness for clinical application in treating IMVM. Furthermore, some scholars reported simultaneous application of physical and chemical treatment could effectively destroy the endothelium of malformed veins (14,15). In some huge and extensive infiltrative types of IMVMs, safe doses of sclerosants are often not enough for a good curative effect.…”