2:26 PM Abstract No. 41 - Percutaneous sclerotherapy of venous malformations: efficacy and safety of ethanol and sotradecol

Abstract

Purpose Venous Malformations are the most common type of vascular malformation in adults, effecting 1-4% of the population; however, the treatment options are relatively limited. Percutaneous sclerotherapy is considered a first line treatment for symptomatic lesions. The purpose of this study is to review the safety and efficacy of ethanol and sotradecol in the treatment of venous malformations. Materials and Methods A retrospective analysis was performed of all patients with venous malformations from 1/1/2000 - 9/1/2012. Lesions were targeted with ultrasound and/or fluoroscopic guidance and venography was then performed through the access needle(s). Venous drainage of the malformation was isolated with a tourniquet and/or direct compression of non target venous structures. The sclerosing agent was then injected to the volume of the lesion as determined on venography. Technical success was defined as the ability to access the lesion, isolate it from non target vessels and deliver the sclerosant. Ethanol or sotradecol were chosen at the operators’ discretion. Lesions in high risk locations (face, hands) were treated preferentially with sotradecol. All patients were followed in IR clinic to asses for response to treatment and complications. Results A total of 186 treatments (136 ethanol, 50 sotradecol) were performed on 95 patients with ages ranging from 9 - 75 (median 30.4). Technical success was 95%. Number of treatment sessions ranged from 1-17 (mean 1.96). Clinical follow up was obtained in 88% of patients. Complete, partial and no relief of symptoms was seen in 35%, 57%, 8% of total treatments; 43%, 48%, 9% of ethanol treatment sessions; and 16%, 80%, 4 % of sotradecol treatment sessions. Complications were seen following 3.7% of ethanol treatment sessions and 2.0% sotradecol treatments. Only complete symptomatic relief (44% vs 18%) was significantly different between the two groups (p=0.0017). Conclusion Percutaneous sclerotherapy of venous malformations is safe. Ethanol and sotradecol are effective agents. In this series, complete symptomatic relief was higher for ethanol than sotradecol. This may reflect significant selection bias as sotradecol is used for lesions in more challenging anatomic locations.