Ethanol Sclerotherapy Of Venous Malformations Research Articles

Venous Malformations Sclerotherapy: Outcomes, Patient Satisfaction and Predictors of Treatment Success.

To retrospectively evaluate the results of sclerotherapy for venous malformations, with emphasis on patient satisfaction, complications and predictors of positive response to treatment. Three hundred and nine patients were treated with ethanol sclerotherapy for venous malformations in our center between the years 2000 and 2014. All of them were sent a self-assessment questionnaire for evaluation of their satisfaction and treatment complications. In total, 153 patients (mean age 21, range 6weeks to 67years) responded to the questionnaire. We analyzed clinical and imaging data from the medical records of these patients. Sixty-four (42%) patients had venous malformations in the lower extremities, 35 (23%) in head and neck regions, 33 (22%) in the trunk, 14 (9%) in the upper extremities and 5 (3%) in the buttock and genitalia. Complete relief of swelling, pain, functional and esthetic complaints was reported in 23%, 22%, 17% and 12% of patients, respectively. Thirty-eight (25%) patients reported being very satisfied with treatment outcomes, 55 (36%) were satisfied, 49 (32%) were not satisfied and 11 (7%) were very unsatisfied. We did not find significant correlations between patient satisfaction and demographics characteristics, lesion location, lesion size, tissue involvement or total sclerosant quantity. The rate of class 3 complications was 7% and that of class 4 complications was 2%. Ethanol sclerotherapy is an effective treatment for venous malformations. Nonetheless, this treatment has a significant complication rate. Patient satisfaction is independent of lesion characteristics and is not as high as may be expected.

Percutaneous Ethanol Sclerotherapy of Venous Malformations of the Oral Cavity and the Oropharynx

Percutaneous Ethanol Sclerotherapy of Venous Malformations of the Oral Cavity and the Oropharynx

Intralesional Lidocaine Anesthesia: A Novel Facilitated Anesthesia Technique for Ethanol Sclerotherapy of Venous Malformation.

The aim of this study was to describe a novel anesthesia, intralesional lidocaine anesthesia (ILA), for ethanol sclerotherapy of venous malformation and evaluate the efficacy and safety. A prospective study of 100 patients with venous malformations undergoing 100 sclerotherapy procedures with intralesional lidocaine anesthesia (ILA) was conducted. Pain was evaluated by numeric rating scale (NRS) immediately following the procedure. The grade of pain was classified by the NRS as no pain (0), mild (1-3), moderate (4-6), and severe (7-10). Local and systemic complications caused by lidocaine were recorded. The median injected volume of absolute ethanol and 0.25% lidocaine was 5.9 mL and 17.0 mL, respectively. In ILA group, 13 patients had no pain during the procedure, 42 patients had mild pain, 38 patients had moderate pain, and 7 patients had severe pain. The mean NRS scores of the whole ILA group were 3.2 (0-8). No local or systemic complications attributed to lidocaine were reported. In a limited series, intralesional lidocaine anethesia seems to be efficient and safe for use in pain management for ethanol sclerotherapy of venous malformation. This anesthesia technique may be a promising first approach for the ethanol sclerotherapy of venous malformations, as it is easy to handle and has minimal sequelae.

Dose-saving isolation procedure in percutaneous ethanol sclerotherapy for venous malformations

To evaluate the feasibility and effectiveness of an isolation technique during ethanol injection sclerotherapy for venous malformations (VMs) in the head and neck region. The subjects were 23 patients with 35 VM lesions in the head and neck, treated between 1999 and 2012. The mean lesion area was 3.75 ± 3.09 cm(2) (±standard deviation). We confirmed the contour of the lesions to be treated on a fully filled image on direct injection cisternography, and observed patterns of communicating drainage to systemic veins. The cisterns were evacuated by squeezing and were isolated by manual compression of the communicators. Ethanol (94.5%) with a contrast agent was then injected into both isolable and unisolable lesions, up to a total volume of 1 mL/cm(2), avoiding complications. We investigated the relationship between lesion size and injected ethanol dose, and also dose per unit area. Both manual evacuation by compression and isolation were performed in 20 (57.1%) isolable lesions, but not in 15 unisolable lesions. The mean injected ethanol dose was 0.65 ± 0.31 mL/cm(2) overall, 0.70 ± 0.32 in isolable and 0.59 ± 0.30 in unisolable lesions (NS). However, the injected ethanol dose was significantly lower for lesions sized >6 cm. Complete to near-complete shrinkage was observed in all isolable lesions, and in 60% of unisolable lesions (P < 0.05). Clinical outcome seemed unrelated to the injected ethanol dose or the dose per unit area. There was one case of recurrence and one complication in the unisolable lesions. No further relapses or complications were observed during the follow-up period of 38.6 ± 12.3 months. Clinical outcome was related to the isolability not to the injected dose. The isolation appears useful for improving the safety and effectiveness of ethanol sclerotherapy for VM.

Ethanol sclerotherapy for treatment of venous malformations of face and neck— a single centre experience

Due to complicated anatomy of the face and neck, complete surgical excision of venous malformation is rarely possible and may lead to bleeding, nerve damage and cosmetic deformity. Sclerotherapy is an alternative method of treatment with few complications. Ethanol shows the lowest rate of malformation recurrence and is the most reliable substance of all of the sclerosing agents. This study aims to evaluate the efficacy of ethanol instillation in venous malformation of the face and neck. Between July 20, 2008, to December 30, 2009, 15 patients with venous malformation of the face and neck were included in the study. After confirmation of diagnosis (combination of history, physical findings and magnetic resonance imaging), percutaneous ethanol (99.5% ethyl alcohol) sclerotherapy was used under DSA road mapping using general anaesthesia. Sclerotherapy provided significant improvement of symptoms for all patients, with no major complications. All patients experienced pain and swelling to a variable degree in the immediate post procedure period that resolved over few days. Ethanol sclerotherapy for venous malformations of the face and neck is a safe and effective treatment option.

Absolute Ethanol Sclerotherapy for Venous Malformations in the Face and Neck

The purpose of the present study was to evaluate the outcomes of sclerotherapy using absolute ethanol for venous malformations in the face and neck. We treated 60 consecutive patients with venous malformations in the face and neck with sclerotherapy with absolute ethanol under the guidance of digital subtraction angiography. Magnetic resonance imaging was used to evaluate the clinical outcomes of sclerotherapy. Complications were also evaluated. The duration of follow-up was a mean of 8 months (range, 3 to 22). Of the 60 patients, 22 were treated once and 38 were treated 2 to 18 times (mean 2.6 times/patient). The mean total volume of ethanol in 60 patients was 11.2 mL (range, 0.5 to 230 mL). Of the 60 patients, 56 had complete volume reduction and a marked response after treatment. No severe skin necrosis or permanent nerve damage occurred. Percutaneous sclerotherapy with absolute ethanol under the guidance of venography is a safe and effective treatment for venous malformations in the face and neck.

Direct percutaneous ethanol instillation for treatment of venous malformation in the face and neck

Venous malformations of the face and neck involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult; high recurrence rates and high morbidity are well documented. Various methods of treatment of uncertain value and risk of complications have been advocated. We present our experience in treating five patients with venous malformation in the face and neck by using direct percutaneous ethanol sclerotherapy. Four patients had large lesions (> or = 3 cm; one patient had two large lesions in the low eyelid), and the other had a mid-sized lesion (1.5-3 cm). Under general or local anaesthesia, one-third to one-quarter cavity volume of ethanol was injected percutaneously, directly into the malformation with under fluoroscopy [de Lorimier AA. Sclerotherapy for venous malformations. J Pediatr Surg 1995;30:188-93; Johnson PL, Eckard DA, Brecheisen MA, Girod DA, Tsue TT. Percutaneous ethanol sclerotherapy of venous malformations of the tongue. Am J Neuroradiol 2002;23:779-82; Pappas DC Jr, Persky MS, Berenstein A. Evaluation and treatment of head and neck venous vascular malformations. Ear Nose Throat J 1998;77:914-22; Lee CH, Chen SG. Direct percutaneous ethanol sclerotherapy for treatment of a recurrent venous malformation in the periorbital region. ANZ J Surg. 2004;74(12):1126-7.]. Four patients required two injections. All patients had remission and alleviation of their symptoms, with no major complications. Direct percutaneous injection of absolute ethanol provides a simple and reliable alternative treatment for venous malformation in the face and neck.

Fatal Cardiovascular Collapse during Ethanol Sclerotherapy of a Venous Malformation

We report a case of fatal cardiovascular collapse that occurred during Ethanol sclerotherapy of a venous malformation in a 21-year-old woman. The malformation was located on the anterior part of the thigh. Fifty ml of a mixture of Ethanol, Ethibloc and Lipiodol containing 35 ml of Ethanol (0.52 ml/kg) were injected under fluoroscopy. A major drop in arterial pressure was recorded after release of the tourniquet placed at the thigh root. The patient died after four hours of intensive cardiac reanimation. Her blood alcohol level was 0.4 g/l one hour after the end of the intervention. The cardiac toxicity of ethanol depends more on the potential acute venous contamination than on the blood alcohol concentration. The currently admitted "safety limit" of 1 ml/kg of bodyweight for ethanol sclerotherapy of venous malformations is certainly unsafe and must be redefined.

Ethanol Sclerotherapy of Venous Malformations: Evaluation of Systemic Ethanol Contamination

To evaluate blood ethanol concentrations immediately after percutaneous ethanol sclerotherapy of venous malformations (VMs). Thirty consecutive sclerotherapy procedures were performed for VMs in various anatomic sites. In a prospective study, the blood parameters monitored were ethanol plasma level (immediately after the procedure), plasma haptoglobin (Hp; before and after the procedure), and standard blood analysis including urea, creatinine, bilirubin, and lactic dehydrogenase (LDH) levels during the hospital stay. The mean amount of 94% ethanol injected was 19.7 mL (0.03-0.78 g/kg of body weight). The observed systemic ethanol levels ranged from 0 to 1.16 g/L (mean, 0.33 g/L, SD = 0.33). The relationship between the observed plasmatic ethanol level (ETOH plasma) measured immediately after the procedure and the maximum expected plasmatic ethanol amount (ETOH max) was linear and significant (correlation coefficient r = 0.91 for all lesions, r = 0.96 for lesions without visible venous drainage, r = 0.86 for lesions with visible draining veins, and r = 0.93 for lobulated VMs). Minimal changes were observed for indicators of hemolysis: macroscopic hemoglobinuria in five of 30, abnormal Hp level in seven of 30, and increase in LDH and increase in bilirubinemia in one case each. Systemic ethanol contamination during sclerotherapy of VMs could be detected in 25 of 30 cases (83.3%). The plasmatic ethanol level was directly proportional to the amount of ethanol injected and not dependent on the VM morphology, venous drainage, or injection technique. Clinicians and interventional radiologists must be aware of this massive ethanol outflow during percutaneous sclerotherapy of VMs and its potentially serious systemic complications.