Indications, Outcomes, Efficacy, and Complications of Percutaneous Sclerotherapy in the Management of Hemangiomas at Kenyatta National Hospital

Abstract

Background The effective management of hemangiomas using percutaneous sclerotherapy optimizes desired clinical outcomes and minimizes the associated complications in affected patients. Intra-lesional sclerotherapy involves injecting a sclerosing agent (such as bleomycin and sodium tetradecyl sulfate) into a lesion or the interstitial space around the lesion, causing endothelial injury, thrombosis, inflammation, scarring, and shrinkage of the lesion. Extensive literature suggests that sclerotherapy has a role in the management of hemangiomas, as demonstrated by better health outcomes and improved quality of life among affected patients. Objectives To evaluate the indications, outcomes, efficacy, and complications of percutaneous intra-lesional sclerotherapy in the management of hemangiomas. Materials and methods The study was a prospective cross-sectional study, conducted at a level 6 National Referral Hospital Interventional Radiology Unit. Patients with hemangiomas referred for intralesional sclerotherapy were treated. Data including the indications of intra-lesional sclerotherapy, short-term outcomes, complications were collected, analyzed, and presented in percentages, graphs, pie charts, tables. Technical and clinical success rates were calculated. The efficacy of intralesional sclerotherapy was analyzed using chi-square test. Results A total of 20 patients with hemangiomas were treated. There were 11 females comprising 55% and 9 males comprising 45% with a male to female ratio of 1:1.2. The commonest indication for referral was pain (21.6%), followed by abnormal swelling (18.9%). Most lesions were located in the liver comprising 25%. Other locations included the hand, cheek, lower lip, lower extremities (calf, distal leg, foot, and thigh), lumbar region, posterior thoracic back region and abdomen mesenteric region. Majority of the patients had significant improvement of clinical symptoms with a p-value <0.05. Similarly, there was a statistically significant reduction in the sizes of the lesions treated with a p-value of <0.05. The technical success rate was 100% and the overall clinical success rate was 90%. Mild pain (10%), mild edema (10%) and skin discoloration (5%) were the commonest minor complications encountered, with no major complications. Conclusion Percutaneous intralesional sclerotherapy is a safe and efficacious treatment of hemangiomas with a high technical and clinical success rate. It should be considered as a first line of treatment for the hemangiomas.