Preliminary Experience With Intraoperative Near-infrared Fluorescence Imaging in Percutaneous Sclerotherapy of Soft-Tissue Venous Malformations

Abstract

It has recently been demonstrated that near-infrared (NIR) fluorescence imaging can be used to visualize the blood vasculature. Although sclerotherapy has been successfully used in treating venous malformations, the spread of sclerosant is difficult to monitor during sclerotherapy. To evaluate the safety and efficacy of NIR fluorescence imaging in percutaneous sclerotherapy of soft-tissue venous malformations. The use of NIR fluorescence imaging after administration of indocyanine green (ICG) was evaluated in duplex-guided sclerotherapy performed on 15 patients with venous malformations. The lower extremities were involved in seven, the upper extremities in four, and the face in four. In 13 of the 15 procedures, spotty fluorescence images were obtained, and in eight procedures, linear fluorescence images were obtained. In two patients with intramuscular venous malformations in the lower extremities, no fluorescence images were obtained. Observational depth seemed to be <1cm below the skin surface with an ICG concentration of 0.01mg/mL. No complications associated with ICG were observed. Adjacent tissue ulceration occurred in one patient. NIR fluorescence imaging with ICG can be a useful additional monitor for percutaneous sclerotherapy of venous malformations, especially in the face and hands, enabling noninvasive assessment of real-time spread of sclerosant.