Abstract
This retrospective study examines the outcomes of sclerotherapy in children with (veno)lymphatic malformations who received sclerotherapy between 2011 and 2016 (116 children, 234 procedures). Complication severity was classified using the Society of Interventional Radiology classification. Clinical response was rated on a scale of 0 (no change) to 3 (good improvement). The sclerosants used were bleomycin (n = 132; 56%), lauromacrogol (n = 42; 18%), doxycycline (n = 15; 6%), ethanol (n = 12; 5%), or a combination (n = 33; 14%). Four major and 25 minor complications occurred without significant differences between the agents. The median response rate per procedure was 2—some improvement—for all sclerosants. However, in pure LMs (67%), bleomycin and a combination of agents resulted in the best clinical response. On patient level, all had some or good clinical response. Mixed macrocystic and microcystic lesions showed a significantly lower clinical response (median 2 versus 3; p = 0.023 and p = 0.036, respectively) and required significantly more procedures (median 2 versus 1; p = 0.043 and p = 0.044, respectively) compared with lesions with one component.Conclusion: Sclerotherapy for (V)LMs in children is safe and effective. Bleomycin is the most frequently used agent in this clinic and seemed most effective for pure LMs. Mixed macrocystic and microcystic lesions are most difficult to treat effectively.What is Known:• A variety of agents can be used for sclerotherapy of lymphatic malformations in children.• Macrocystic lesions have favorable outcomes compared with microcystic and mixed lesions.What is New:• Bleomycin and a combination of agents seem to be most effective to treat lymphatic malformations in children.• Mixed macrocystic and microcystic lesions are more difficult to treat effectively compared with lesions with either one of these components.
Highlights
Lymphatic malformations (LMs) are congenital developmental anomalies of the lymphatic system, with or without a venous component [1]
In a systematic review on agents used for sclerotherapy, it is concluded that the optimal sclerotherapy could not be identified and that the difference in complication rates could be the deciding factor in the choice between agents [18]
A pure LM was diagnosed in 78 patients (67%) and a VLM in 38 patients (33%)
Summary
Lymphatic malformations (LMs) are congenital developmental anomalies of the lymphatic system, with or without a venous component (venolymphatic malformation; VLM) [1]. Several studies evaluated treatment outcomes after use of various agents for sclerotherapy in (V)LMs [7,8,9,10,11,12,13,14,15,16,17] Most of these studies included small patient cohorts [9, 16, 17] or both adults and children [8, 11, 12, 15], which could confound or bias the results. In a systematic review on agents used for sclerotherapy, it is concluded that the optimal sclerotherapy could not be identified and that the difference in complication rates could be the deciding factor in the choice between agents [18]
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