Predictors of response to percutaneous ethanol sclerotherapy (PES) in patients with venous malformations: analysis of patient self-assessment and imaging.
BACKGROUND
Percutaneous ethanol sclerotherapy (PES) is the primary tool in the treatment of venous malformations (VM). However, PES has known serious complications. This study is aimed at identifying predictors of good response to PES in patients with VM to improve patient selection.


METHODS
We performed a retrospective, cross-sectional study of 158 VM patients (mean age, 14.3 years, male 42%) who underwent ethanol sclerotherapy at a specialized vascular malformation center. For clinical result assessment, patients or parents in pediatric patients answered questions on symptomatic, functional, and cosmetic improvement after PES. In each category, the possible choices were markedly improved, moderately improved, no change, moderately worse, or markedly worse compared with pretreatment status. A "good response" was defined as one or more areas of marked improvement on the self-assessment in conjunction with marked improvement on post-treatment images (> or =30% decrease in maximal diameter of VM on magnetic resonance imaging [MRI] or > or =50% decrease in abnormal blood pool ratio on whole body blood pool scintigraphy [WBBPS] compared with pretreatment images). To determine predictors of a good response to PES, uni- and multivariate analysis were conducted on demographics (age, gender), clinical features of VM (location, size, depth of involved tissue, presence of associated lymphatic malformation, MRI findings; well-defined vs ill-defined margin, characteristics of venous drainage during PES) and treatment variables (number of PES sessions, maximal concentration and dosage of ethanol used in PES, adjuvant therapy).


RESULTS
Symptomatic, functional, and cosmetic improvement was 28%, 27%, and 34%, respectively, based on patient questionnaires. Based on imaging studies, 42 patients (27%) had markedly improvement. Composite outcome combining questionnaire results and imaging study showed that 16% of patients had a "good response". On multivariate analysis, female gender (odds ratio [OR]: 4.49, 95% confidence interval [CI]: 1.24-16.28), no or delayed visualization of drainage vein (OR: 9.22, 95% CI: 1.79-47.51), and a well-defined margin on MRI (OR: 13.38, 95% CI: 2.84-63.12) were independent predictors of "good response" to PES.


CONCLUSIONS
PES should be performed in selected patients in order to obtain the best outcomes and minimize complications. No or delayed visualization of drainage vein on initial direct puncture venogram, a well-defined margin on MRI, and female gender were statistically significant predictors of a "good response" to PES and may be useful in selecting patients.
Yun
Woo-Sung
WS
Congenital Vascular Malformation Clinic, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim
Young-Wook
YW
Lee
Kyung-Bok
KB
Kim
Dong-Ik
DI
Park
Kwang-Bo
KB
Kim
Keon-Ha
KH
Do
Young-Soo
YS
Lee
Byung-Boong
BB
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D016017:Odds Ratio; D018579:Patient Selection; D010690:Phlebography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D012647:Self-Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000175:diagnosis / Q000628:therapy*; D014680:Veins / Q000002:abnormalities / Q000473:pathology; D055815:Young Adult
D012597:Sclerosing Solutions; D000431:Ethanol