Soft-tissue venous malformations in children: percutaneous sclerotherapy with Ethibloc

Thirty-eight children with soft-tissue venous malformations (VMs) were treated with percutaneous injection of a new fibrosing agent (Ethibloc). The technique, results, side effects, and complications are detailed. Direct puncture of the VM allows evaluation of the draining venous system and direct injection of Ethibloc. This procedure alone or associated with surgery led to achievement of good or excellent results in 74% of the cases (complete cure in 50%), with minimal side effects and no major complications.     

Effects of blood flow control on clinical outcomes after ethanolamine oleate sclerotherapy for vascular malformations

Purpose  

The purpose of this study was to assess the control of nidus blood flow and the association between such control and clinical outcomes after ethanolamine oleate (EO) sclerotherapy for vascular malformations.     

MR导引下经皮硬化治疗四肢静脉血管畸形

目的 探讨MR导引下经皮硬化治疗四肢静脉血管畸形的操作方法及临床应用价值.方法 在0.35 T开放式MR扫描仪的导引下应用18或20 G核磁兼容针对28例下肢静脉血管畸形患者进行经皮穿刺及硬化治疗.在治疗后6个月进行随访,分析其治疗效果.评价指标包括:(1)介入操作是否成功;(2)患者的症状有无改善;(3)有无并发症;(4)病变体积的变化;(5)病变对比信噪比(CNR)的变化.治疗前后病变体积及CNR的比较使用配对t检验进行分析.结果 28例患者先后共进行57次硬化治疗,手术操作均获得成功,没有出现严重并发症.所有患者的症状均有较明显改善,特别是疼痛、功能障碍等症状.病变体积出现不同程度的缩小,治疗前平均为(56.8±11.7)cm3,治疗后平均为(27.0±7.2)cm3,差异有统计学意义(t=8.90,P<0.01),缩小率为28.5%～74.4%,平均为(54.4±5.3)%.同时,MRI显示治疗后病变的信号降低,CNR治疗前平均为21.9±2.0,治疗后平均为8.4±0.9,差异有统计学意义(t=21.76,P<0.01),CNR降低率为40.0%～78.0%,平均为(61.0±3.6)%.结论 MR引导下经皮硬化治疗四肢静脉血管畸形是安全、有效的新技术.     

颅面部静脉畸形的无水乙醇介入硬化治疗

目的 总结无水乙醇介入硬化治疗颅面部静脉畸形的经验.方法 130例颅面部静脉畸形患者,均采用DSA监视下经皮穿刺无水乙醇硬化治疗.结果 130例患者共接受硬化治疗275次(1～18次/例),平均2.1次/例;单次治疗中的无水乙醇用量为0.5～40ml/次(平均10.3 ml次).随访时间为5～25个月(平均16个月).95例治愈,30例明显缓解.结论 无水乙醇介入硬化治疗颅面部静脉畸具有肯定疗效.     

Ethanol sclerotherapy of peripheral venous malformations

BACKGROUND: Venous malformations are congenital lesions that can cause pain, decreased range of movement, compression on adjacent structures, bleeding, consumptive coagulopathy and cosmetic deformity. Sclerotherapy alone or combined with surgical excision is the accepted treatment in symptomatic malformations after failed treatment attempts with tailored compression garments. OBJECTIVES: To report our experience with percutaneous sclerotherapy of peripheral venous malformations with ethanol 96%. PATIENTS AND METHODS: 41 sclerotherapy sessions were performed on 21 patients, aged 4-46 years, 15 females and 6 males. Fourteen patients were treated for painful extremity lesions, while five others with face and neck lesions and two with giant chest malformations had treatment for esthetic reasons. All patients had a pre-procedure magnetic resonance imaging (MRI) study. In all patients, 96% ethanol was used as the sclerosant by direct injection using general anesthesia. A minimum of 1-year clinical follow-up was performed. Follow-up imaging studies were performed if clinically indicated. RESULTS: 17 patients showed complete or partial symptomatic improvement after one to nine therapeutic sessions. Four patients with lower extremity lesions continue to suffer from pain and they are considered as a treatment failure. Complications were encountered in five patients, including acute pulmonary hypertension with cardiovascular collapse, pulmonary embolus, skin ulcers (two) and skin blisters. All patients fully recovered. CONCLUSION: Sclerotherapy with 96% ethanol for venous malformations was found to be effective for symptomatic improvement, but serious complications can occur.     

MRI-guided percutaneous sclerotherapy of venous malformations: initial clinical experience using a 3T MRI system

PurposeVenous malformations (VMs) are low-flow vascular anomalies that are commonly treated with image-guided percutaneous sclerotherapy. Although many VMs can be safely accessed and treated using ultrasonography and fluoroscopy, some lesions may be better treated with magnetic resonance imaging (MRI)–guided sclerotherapy. The aim of this study is to evaluate the feasibility, efficiency, and outcomes of MRI-guided sclerotherapy of VMs using a 3T MRI system.MethodsSix patients with VMs in the neck (n = 2), chest (n = 1), and extremities (n = 3) underwent sclerotherapy with 3T MRI guidance. Feasibility was assessed by calculating the technical success rate and procedural efficiency. Efficiency was evaluated by using planning, targeting, intervention, and total procedure times. Outcomes were assessed by measuring VM volumes before and after sclerotherapy, patient-reported pain scores, and occurrence of complications.ResultsTechnical success was achieved in all 6 procedures. There was a non-significant 30% decrease in mean VM volume after the procedure (P = .350). The procedure resulted in a decrease in mean pain score (on an 11-point scale) of 2.6 points (P = .003). After the procedure, 4 patients reported complete pain resolution, 1 reported partial pain resolution, and 1 reported no change in pain. Procedural efficiency was consistent with similar sclerotherapy procedures performed at our institution. There were no major or minor complications.Conclusion3T MRI guidance is feasible for percutaneous sclerotherapy of VMs, with promising initial technical success rates, procedural efficiency, and therapeutic outcomes without complications.     

DSA导引下经皮硬化治疗儿童阴茎区静脉畸形的效果和安全性

目的 探讨DSA导引下经皮硬化治疗儿童阴茎区静脉畸形的效果和安全性.方法 回顾性分析2016年1月至2017年6月山东大学齐鲁儿童医院采用经皮穿刺硬化治疗的11例阴茎区静脉畸形患儿临床资料.DSA透视下行局部静脉造影,判断瘤巢形态、范围和引流静脉回流情况.根据造影流速情况选择硬化剂(平阳霉素或聚多卡醇),DSA监视下经...     

Ethanol sclerotherapy of venous malformations: evaluation of systemic ethanol contamination

PURPOSE: To evaluate blood ethanol concentrations immediately after percutaneous ethanol sclerotherapy of venous malformations (VMs). MATERIALS AND METHODS: Thirty consecutive sclerotherapy procedures were performed for VMs in various anatomic sites. In a prospective study, the blood parameters monitored were ethanol plasma level (immediately after the procedure), plasma haptoglobin (Hp; before and after the procedure), and standard blood analysis including urea, creatinine, bilirubin, and lactic dehydrogenase (LDH) levels during the hospital stay. RESULTS: The mean amount of 94% ethanol injected was 19.7 mL (0.03-0.78 g/kg of body weight). The observed systemic ethanol levels ranged from 0 to 1.16 g/L (mean, 0.33 g/L, SD = 0.33). The relationship between the observed plasmatic ethanol level (ETOH plasma) measured immediately after the procedure and the maximum expected plasmatic ethanol amount (ETOH max) was linear and significant (correlation coefficient r = 0.91 for all lesions, r = 0.96 for lesions without visible venous drainage, r = 0.86 for lesions with visible draining veins, and r = 0.93 for lobulated VMs). Minimal changes were observed for indicators of hemolysis: macroscopic hemoglobinuria in five of 30, abnormal Hp level in seven of 30, and increase in LDH and increase in bilirubinemia in one case each. CONCLUSIONS: Systemic ethanol contamination during sclerotherapy of VMs could be detected in 25 of 30 cases (83.3%). The plasmatic ethanol level was directly proportional to the amount of ethanol injected and not dependent on the VM morphology, venous drainage, or injection technique. Clinicians and interventional radiologists must be aware of this massive ethanol outflow during percutaneous sclerotherapy of VMs and its potentially serious systemic complications.     

Percutaneous ethanol sclerotherapy of venous malformations of the tongue

BACKGROUND AND PURPOSE: Percutaneous ethanol sclerotherapy has been reported to be efficacious for head and neck venous malformations. We sought to evaluate the safety and efficacy of percutaneous sclerotherapy by using ethanol for treatment of symptomatic venous malformations of the tongue. METHODS: Eleven sclerotherapy procedures were performed in seven patients from January 1995 to February 2001. Patient age ranged from 19 months to 57 years (mean age, 32 years). Four patients were male and three were female. Mean follow-up was 36 months. The volume of ethanol used per treatment session ranged from 2 to 32 cc (mean, 16 cc). RESULTS: Sclerotherapy provided significant improvement or resolution of symptoms for all patients. There were no major complications. One patient had a small (3 x 2 cm) area of skin blistering at the injection site. All patients experienced pain and swelling to a variable degree. Sclerotherapy resulted in resolution of symptoms in six of seven patients. Three patients had resolution of symptoms after one procedure. Four patients each underwent two sclerotherapy procedures. One patient who remained symptomatic but improved after undergoing two procedures underwent an anterior glossectomy and is now asymptomatic. CONCLUSION: Percutaneous ethanol sclerotherapy is a safe and effective method of treating symptomatic venous malformations of the tongue.     

Ultrasound-guided percutaneous injection of ethanolamine oleate for hypersplenism. An experimental study in dogs

In order to evaluate a possible therapy for hypersplenism, an experiment with animals was done. In nine dogs, 0.6 ml/kg body weight of 5% ethanolamine oleate was injected percutaneously into the spleen under ultrasound guidance. The injection was repeated three times at intervals of 1 week. Three dogs each were killed at 1, 4, and 8 weeks after the final injection. All dogs tolerated the procedure well and lived until they were killed. The platelet count and leukocyte count increased after the injections, and remained higher than the pretreatment level until death. This effect probably is due to depressed splenic function. The autopsy showed 40% of the spleen to be infarcted with complete destruction of the normal structure. No serious complications occurred. In addition, injection of ethanolamine oleate in six fully heparinized dogs showed that there was little risk of hemorrhage. Ultrasound-guided percutaneous injection of ethanolamine oleate might be a simple and effective therapy for hypersplenism.     

Polidocanol sclerotherapy for painful venous malformations: evaluation of safety and efficacy in pain relief

The aim of this study was to retrospectively evaluate the safety and efficacy of polidocanol sclerotherapy in pain relief for painful venous malformations (VMs). Thirty-one patients with painful VMs underwent polidocanol sclerotherapy. Pain intensity was assessed with an 11-point verbal numerical rating scale. Sclerotherapy was technically successful in 58 (98.3%) of 59 sessions. Twenty-six (89.7%) out of 29 patients experienced an improvement in pain after sclerotherapy at follow-up, a mean of 46 months after treatment. The mean pain score improved from 6.6?±?2.5 before treatment to 2.4?±?2.9 after treatment (P <.001). The factors that significantly influenced the therapeutic effect were size of lesion (P?=?.008), margin of lesion (P?=?.006), and stasis of sclerosant (P?=?.032). Adverse events included hypotension and bradycardia during the procedure. No major complication occurred. Polidocanol sclerotherapy is safe and most efficacious in providing pain relief for patients with small VMs (equal to or less than 10 cm in diameter), VMs with a well-defined margin, and VMs with good stasis of sclerosant during sclerotherapy.     

Low-flow vascular malformations: MR-guided percutaneous sclerotherapy in qualitative and quantitative assessment of therapy and outcome

PURPOSE: To prospectively assess the therapeutic procedure and outcome of magnetic resonance (MR)-guided percutaneous sclerotherapy in patients with low-flow vascular malformations. MATERIALS AND METHODS: Seventy-six percutaneous sclerotherapy treatments were performed by one radiologist with real-time MR guidance in 15 patients (six female patients; mean age, 54.4 years +/- 11.1; nine male patients; mean age, 32.9 years +/- 14.1) with vascular malformations in the head and neck (n = 64), spine (n = 5), and extremities (n = 7). Qualitative assessment was used to analyze (a) individual success of therapy, (b) occurrence of complications, (c) time required for minimally invasive MR-guided sclerotherapy in regression analysis, (d) ability of MR imaging to depict postinterventional perfusion changes within the vascular malformation with calculation of changes in contrast-to-noise ratios, and (e) detection of volume changes at follow-up examinations with volumetric analysis. RESULTS: Percutaneous sclerotherapy was performed successfully and without complications by filling targeted vascular malformations with sclerosing agent. Induced vascular sclerosis was used to successfully treat individual predominant symptoms, such as hemorrhage, pain, cosmetic disfigurement, and functional impairment. Quantitative analysis focusing on the actual interventional length of time presented an acceleration over the 5-year time period, matching a cubic function in regression curve fit and taking 31 minutes 50 seconds +/- 14 minutes. Induced vascular thrombosis was identified in all treated portions on postinterventional images by the statistically significant changes in contrast-to-noise ratio (P < .05) compared with preinterventional imaging. On follow-up images (ie, those obtained after 12 weeks +/- 6), shrinkage was observed in targeted portions (67.2% +/- 18.9). CONCLUSION: MR imaging allows safe guidance and monitoring of minimally invasive sclerotherapy and permits verification of therapeutic success postinterventionally and during follow-up examinations.     

Ethanol threshold doses for systemic complications during sclerotherapy of superficial venous malformations: a retrospective study

Introduction  

Ethanol has been used for many years for superficial venous malformations (VM) sclerotherapy. Although ethanol is well-tolerated in most of the cases, systemic side effects have been reported in some patients, including cardiac collapse and death. Systemic toxic side effects have been suspected to be proportional to the ratio of ethanol dose divided by the patient's body weight (dose/weight ratio in millilitre per kilogram). No extensive study has yet been conducted to determine the toxic threshold, and no consensus exists on this point.     

Craniofacial venous plexuses: angiographic study

Venous drainage patterns at the craniocervical junction and skull base have been thoroughly described in the radiographic literature. The facial veins and their important anastomoses with the intracranial venous system are less well appreciated. This study of 54 consecutive normal cerebral angiograms demonstrates that visualization of the pterygoid plexus as well as the anterior facial, lingual, submental, and ophthalmic veins can be normal on common carotid angiograms. In contrast to previous reports, opacification of ophthalmic or orbital veins occurs in most normal internal carotid arteriograms. Visualization of the anterior facial vein at internal carotid angiography can also be normal if the extraocular branches of the ophthalmic artery are prominent and nasal vascularity is marked.     

Idiopathic varicoceles: feasibility of percutaneous sclerotherapy

Percutaneous retrograde venography was performed in 717 patients with a left-sided idiopathic varicocele. In 674 (94.0%), testicular (internal spermatic) vein insufficiency was proved by contrast medium reflux from the left renal vein into the testicular vein, down to the pampiniform plexus. The different venographic patterns of the testicular veins were classified into seven basic types. Five of these, comprising 624 patients, had incompetent or missing valves all along the trunk of the testicular vein. In 554 of the 624 (88.8%), sclerotherapy was performed, but such treatment was possible in only three of 50 patients with a competent orifice valve bypassed by an insufficient collateral (type IVb). In 43 of the 717 patients (6.0%), no insufficient vein could be found at all (type 0). The mean fluoroscopy time was 4.4 minutes. There were no serious complications associated with venography or sclerotherapy, and the initial recurrence rate was 9.8%. Percutaneous sclerotherapy is therefore a simple, safe, and effective treatment of testicular vein insufficiency and is suitable for almost 80% of patients with varicoceles.     

Navigation-assisted sclerotherapy of orbital venolymphatic malformation: a new guidance technique for percutaneous treatment of low-flow vascular malformations

Percutaneous sclerotherapy of orbital low-flow vascular malformations requires precise procedural guidance. For the treatment of a patient with an orbital venolymphatic malformation, we sought to optimize guidance by combining navigation assistance for needle placement with intralesional contrast medium injection for assessment of venous drainage. By using a surgical navigation system (Vector Vision, BrainLAB, Munich, Germany), multiplanar target lesion visualization was performed after fusion of CT and MR imaging data, which allowed precise puncture planning.