Educational Exhibit Abstract No. 290 - Percutaneous sclerosis of low-flow vascular malformations: technical considerations and comparison of sclerosants

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Learning Objectives 1. Provide an overview of venous and lymphatic malformations. 2. Review the role of percutaneous sclerotherapy in their management. 3. Discuss technical considerations when performing percutaneous sclerosis. 4. Compare maximum doses, relative advantages and associated complications of available sclerosants. 5. Review outcomes after sclerotherapy, including change in lesion size, symptom relief, side effects and complications. Background 1. Low-flow vascular malformations are congenital lesions related to capillary, venous and lymphatic development that commonly occur in the head and neck and cause pain and symptoms related to compression of adjacent structures. 3. Treatments options include observation, surgical resection or percutaneous sclerotherapy. 4. Available sclerosants include ethanol, doxycycline, bleomycin and detergents. Clinical Findings/Procedure Details 1. Pretreatment imaging with MR or US can help characterize the lesion, including the presence of a large draining vein (venous) or size of internal cysts (lymphatic). 2. Large draining veins are occluded using endovascular techniques, manual compression or surgical ligation to increase dwell time and minimize systemic administration of sclerosant. 3. Cystic fluid in lymphatic malformations is aspirated prior to sclerosis. 4. Analgesics and steroids help reduce postprocedure pain and swelling related to inflammation. 5.The majority of malformations require repeat treatments. Conclusion and/or Teaching Points 1. Low-flow vascular malformations should be managed by a multidisciplinary team that includes interventional radiologists. 2. Percutaneous sclerotherapy is widely considered first line therapy for lymphatic and venous malformations. 3. Different sclerosants have distinct advantages and associated complications. 4. Pretreatment imaging and close postprocedure monitoring are used to minimize the extent of side effects and risk of complications.