ABSTRACT

To review the therapeutic results of the combination of embolization and sclerotherapy, with or without surgery, in patients with peripheral vascular malformations (PVMs).

A total of 40 patients (24 males and 16 females) with PVMs, who were treated via percutaneous embolization (transarterial [TA] versus direct puncture [DP]) and sclerotheraphy between March 2003 and September 2009, were included in this retrospective study. The mean age was 28 years (range, 6–66 years), and 9 patients (7 boys, 2 girls) were ≤18 years of age (range, 6–18 years). The 40 patients experienced 40 PVMs, of which 15 were localized to an upper extremity, 13 to a lower extremity, 7 to the axial body, and 5 to the pelvis. A total of 22 PVMs were high-flow, whereas 18 were low-flow. Indications for treatment included pain, swelling, extremity function loss, and cosmetic concerns.

A total of 85 embolization/sclerotheraphy sessions were performed (2.1 sessions per patient). For the 22 high-flow PVMs, 53 treatment sessions were completed (2.4 sessions per lesion). Of the high-flow PVMs, 10 were treated via embolization only (7 DP, 2 TA, 1 DP and TA), 5 via alcohol sclerotheraphy only (2 DP, 2 TA, 1 DP and TA) and 7 via a combination of embolization and sclerotheraphy (3 TA, 4 DP and TA). The agents of embolization and sclerotherapy were n-butyl cyanoacrylate (n=22 patients), Onyx® (n=12 patients), and alcohol (n=19 patients). A total of 18 low-flow PVMs were treated in 32 sessions (1.8 sessions per lesion), all via the direct puncture approach. Of the low-flow PVMs, 11 were treated with embolization only, 6 with sclerotheraphy only, and 1 with a combined approach. In 16 patients (6 high-flow versus 10 low-flow), after a mean of 2.1 sessions (range, 1–9 sessions), the percutaneously treated lesions were excised by surgery without any major complications. In the 24 patients who did not have surgery, the lesions significantly decreased in size and the complaints from these patients improved. In four patients, skin ulcerations were identified, two of these patients needed surgical grafting; whereas in one patient, sciatic nerve paralysis developed after trans-arterial embolization and recovery was achieved in six months.

Percutaneous treatment of PVMs by embolization and sclerotheraphy is a safe and effective method, provided that appropriate lesion classification and treatment agent selection are performed.

Keywords: vascular malformation, embolization, sclerotherapy