Abstract No. 656 Percutaneous cryoablation of fibro-adipose vascular anomaly: safe and effective therapy

Abstract

Fibro-adipose vascular anomalies (FAVAs) are complex vascular malformations typically presenting with lifestyle limiting pain and at times contractures. FAVAs are difficult to treat typically with poor response to sclerotherapy. Recently a small series of pediatric patients was published showing percutaneous cryoablation to be a safe and effective treatment. The purpose of our study was to evaluate the efficacy and clinical outcomes of image-guided cryoablation in pediatric and adult patients with FAVA either as primary therapy or after prior failed interventions. A retrospective review was performed of all patients undergoing percutaneous image-guided cryoablation with preprocedure imaging or biopsy consistent with FAVA from 10/2014 to 9/2017 at two institutions. There were 10 patients’ ages 9-40 (mean age 22.2 years) and 13 ablations. Pre-procedure, intraprocedural, and, when available, follow-up imaging was reviewed. EMR review was performed to determine demographics, indication, prior treatments both interventional and surgical, symptoms, and clinical response after the procedure and at any subsequent follow-up visits, as well as any complications. Response was categorized as complete resolution of pain, marked improvement (now able to perform activities previously limited by pain or no longer requiring pain medication), minimal improvement, and no improvement. The indication for all primary procedures was pain. The indications for repeat ablation was residual pain (n = 2) and ablation of another site (n = 1). Cryoablation was performed under ultrasound (n = 4), CT (n = 8), or combined ultrasound and CT guidance (n = 1). Five of the 10 patients had prior surgical resection, sclerotherapy, or embolization with recurrence of symptoms. Three patients had a complete response, 6 patients had marked improvement, and 1 patient was lost to follow-up. There were 6 minor complications including temporary numbness, scab at the access site, hematoma, and skin discoloration that resolved. There were no major complications. Cryoablation is safe and effective for treatment of adult and pediatric FAVA lesions either as primary therapy or after failed prior interventions.