Sonographically guided percutaneous sclerosis using 1% polidocanol in the treatment of vascular malformations.
OBJECTIVE
The aim of this prospective study was to assess the safety and efficacy of sonographically guided percutaneous injection of 1% polidocanol for sclerosis of peripheral vascular malformations.


METHODS
Patients with vascular malformations of soft tissues were invited to enroll in the study. Gray-scale and color Doppler sonography were performed to determine the texture, margins, and size of the lesions and to determine whether high-velocity blood flow was present. Using real-time sonographic guidance, lesions were punctured with a 20/21-gauge spinal needle. When possible, venous return was occluded before injection. For each injection, 1-6 ml of 1% polidocanol was injected into 1 or more sites within the lesion. The sclerosing agent was not aspirated after injection. Repeat radiography was performed 1 month after each injection session. The procedure was repeated if the patient did not have a complete response, defined as an 80% or greater decrease in the volume of the lesion or resolution of the presenting symptoms.


RESULTS
Of the 15 patients enrolled, 9 had venous malformations, 3 had lymphangiomas, 1 had a recurrent aneurysmal bone cyst, 1 had a venous pseudoaneurysm, and 1 had an arteriovenous malformation of the pinna. Each patient received 1-20 injections of 1% polidocanol (mean +/- standard deviation, 3.3 +/- 4.8 injections). This treatment resulted in a complete response of 7 venous malformations, 3 lymphangiomas, and the arteriovenous malformation and partial response of 2 venous malformations, the recurrent aneurysmal bone cyst, and the venous pseudoaneurysm. Only minor complications occurred.


CONCLUSIONS
Sonographically guided percutaneous injection of 1% polidocanol for sclerosis of peripheral vascular lesions is simple, effective, and safe. This technique is especially effective in cases of soft tissue venous malformation and lymphangioma.
Jain
Rajeev
R
Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110-029, India.
Bandhu
Suman
S
Sawhney
Sukhpal
S
Mittal
Ravi
R
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000628:therapy*; D002648:Child; D005121:Extremities / Q000098:blood supply; D006801:Humans; D015552:Injections, Intralesional; D008202:Lymphangioma / Q000628:therapy; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional; D014680:Veins / Q000002:abnormalities
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols