3:38 PM Abstract No. 162 - A test of nerves. The incidence of neuropathy following sts sclerotherapy of venous malformations

Abstract

Purpose Sclerotherapy is widely advocated as the treatment of choice for venous malformations (VMs). Several sclerotherapy agents are available and a range of risk factors are associated with their use. There are almost no examples of neuropathy resulting from sodium tetradecyl sulfate (STS) published in the literature. We report our experience of neuropathy as a complication of STS sclerotherapy. Materials and Methods All VM sclerotherapy procedures performed between 1999-2012 were reviewed. Standard technique was used with STS as foam, formed from a 1:1:2 mixture of iohexol contrast, air and 3% STS. At the time of treatment technical details were recorded for all procedures including needle size and insertion technique, number, location and classification of treated lesions, the volume and nature of sclerosant used and whether steroids or antibiotics were given. All nerve lesions were recorded. Routine follow-up included post-operative assessment, post discharge telephone call and outpatient clinic appointments. Results 847 procedures were performed. Motor and/or sensory nerve lesions occurred after 10 (1.2%) of 847 procedures. 7 of the 10 cases were in patients that had undergone at least 1 previous sclerotherapy procedure. Neuropathy was seen following treatment of 5 Puig type II lesions, 5 type III and a single type I lesion. Nerve lesions were managed according to clinical need including surgical consultant with a peripheral nerve specialist, physiotherapy and nerve conduction studies. Neuropathy improved in all cases with complete resolution in 7 and partial resolution in 3 patients of whom two required surgery. Conclusion Nerve injury is a rare complication of STS sclerotherapy and an important factor to consider when deciding to treat VMs. A degree of recovery was seen in most patients, but may be incomplete. The literature to date doesn't report neuropathy with STS but our series demonstrates that nerve injury can occur. We advocate active management of neuropathy with physiotherapy, nerve conduction studies and surgical consultation. Long-term follow up is recommended. The authors advocate sharing of clinical information of sclerotherapy complications, to enable prevention, appropriate management and prognostication of lesions.