Colour duplex ultrasound-guided sclerotherapy: a new approach to the management of patients with peripheral vascular malformations.
BACKGROUND
Colour duplex ultrasound (CDU)-guided sclerotherapy is a valuable modality for treating peripheral vascular malformations (PVMs).


METHODS
Between April 1996 and October 1998, 75 patients (age 5-65 years) with PVMs were subjected to CDU. Sclerotherapy was subsequently performed on 40 patients, without sedation, using 3% sodium tetradecyl sulfate, with mean follow-up of 4 years.


RESULTS
CDU of the 33 high-flow lesions (HFLs) revealed direct arteriovenous (AV) communicating channels with very high forward diastolic flow in seven lesions (arteriovenous fistulas, AVFs), but not in the other 25 lesions (non-AVF). One was a mixed lesion picked up by CDU. Sixteen HFLs were subjected to sclerotherapy; 13 (81.25%) regressed. CDU of the 42 low-flow lesions (LFLs) helped categorize them into Type 1, where no supplying arteries could be seen (12 lesions), and Type 2, where supplying arteries were seen (30 lesions). Type 2 lesions could be further subcategorized based on the spectral trace of their supplying arteries: Type 2a, high-resistance flow (25 lesions); and Type 2b, low-resistance flow with a small forward diastolic flow (5 lesions). Twenty-four LFLs were subjected to sclerotherapy; 20 (83.3%) regressed.


CONCLUSIONS
CDU findings correlated well with the clinical appearances of PVMs, and helped to further subcategorize these lesions based on flow. Significant differences in the Doppler flowmetry parameters of the supplying arteries seen in the HFLs and LFLs have enabled us to suggest values for differentiating between them. CDU was also found to be valuable in the follow-up of these lesions.
Mahesh
Balakrishnan
B
Department of Surgery, All India Institute of Medical Sciences, New Delhi, India. drbmahesh@hotmail.com
Thulkar
Sanjay
S
Joseph
George
G
Khazanchi
Rakesh K
RK
Srivastava
Anurag
A
D000015:Abnormalities, Multiple / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries / Q000002:abnormalities / Q000000981:diagnostic imaging; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D001783:Blood Flow Velocity / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D015911:Sclerotherapy / Q000379:methods; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014680:Veins / Q000002:abnormalities / Q000000981:diagnostic imaging