Color duplex-guided sclerotherapy for the treatment of venous malformations.
BACKGROUND
Although surgical extirpation is the standard method for the treatment of vascular malformations, this procedure often leads to loss of motor function, nerve damage, and massive bleeding if the excision is extensive. Sclerotherapy is an alternative method of treatment for venous malformations.


OBJECTIVE
This study was conducted to assess the effect of color duplex ultrasound-guided sclerotherapy on venous malformations and the coagulability induced by sclerosing solution.


METHODS
Twenty-eight patients with venous malformations underwent percutaneous sclerotherapy by direct puncture under duplex ultrasound guidance. Intravenous catheters were inserted into duplex ultrasound-confirmed venous spaces and fine plastic tubing filled with normal saline was attached to the needle. When the needle tip was observed to pierce the vein wall, aspiration of the blood confirmed its intraluminal position. The mean volume of 3.6 ml of 3% polidocanol was injected. Subfascial ligation of the lateral marginal venous collector was performed in patients with Klippel-Trenaunay syndrome. D-dimer (DD) and thrombin-antithrombin III (TAT) were measured preoperatively and on the first and fifth postoperative days.


RESULTS
The head and neck, which was the most common site of venous malformations were involved in 57% of the patients. Venous malformations disappeared in 44% of the patients and decreased in 28%. Localized pain was the most common complication, occuring in 82% of the patients. Sclerotherapy for venous malformations produced significant swelling in 75% of the patients, which required 5-7 days to subside. Significant differences were detected in both DD and TAT concentrations on the first and fifth postoperative days.


CONCLUSIONS
Color duplex-guided sclerotherapy was effective in 82% of the patients. This procedure prevents intra-arterial injection accidents. Although patients with venous malformations showed greater coagulability, no serious thrombotic sequelae were found.
Yamaki
T
T
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan. yamaki-t@po.iijnet.or.jp
Nozaki
M
M
Sasaki
K
K
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007715:Klippel-Trenaunay-Weber Syndrome; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000009:adverse effects; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional; D014680:Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols