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.


OBJECTIVE
To report our experience with percutaneous sclerotherapy of peripheral venous malformations with ethanol 96%.


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.


CONCLUSIONS
Sclerotherapy with 96% ethanol for venous malformations was found to be effective for symptomatic improvement, but serious complications can occur.
Rimon
U
U
Department of Diagnostic Imaging, Interventional Radiology Sectionm Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel. rimonu@sheba.health.gov.il
Garniek
A
A
Galili
Y
Y
Golan
G
G
Bensaid
P
P
Morag
B
B
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D000431:Ethanol / Q000009:adverse effects / Q000627:therapeutic use*; D005145:Face / Q000098:blood supply; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D015552:Injections, Intralesional; D035002:Lower Extremity / Q000098:blood supply; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply; D011655:Pulmonary Embolism / Q000209:etiology; D012597:Sclerosing Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000009:adverse effects; D012769:Shock / Q000209:etiology; D012883:Skin Ulcer / Q000209:etiology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply; D014680:Veins / Q000002:abnormalities*
D012597:Sclerosing Solutions; D000431:Ethanol