Sclerotherapy Sessions Research Articles

Doxycycline sclerotherapy in children with lymphatic malformations: outcomes, complications and clinical efficacy

Lymphatic malformations (LMs) are congenital lesions of the lymphatic system and consist of lymphatic channels and cystic spaces of varying sizes. Recent evidence has shown that LMs respond well to intralesional sclerotherapy. The purpose of this retrospective study is to evaluate the outcome and efficacy of using doxycycline in treating macrocystic, microcystic and combined macro- and microcystic LMs in a tertiary-care pediatric center. Fifty children (32 boys, 18 girls) underwent doxycycline sclerotherapy for treatment of LMs between January 2005 and October 2010. Demographics, imaging, doxycycline treatment details, complications and follow-up details were documented. The mean age at first treatment was 5.9 years (3 days-17.8 years), median 4.2 years. Cervicofacial (19/50 children) and truncal (16/50 children) locations were the most frequently affected. One hundred forty-six sclerotherapy sessions were performed in 50 children (mean 2.9/child). The mean doxycycline dose/kg body weight for 146 sessions was 15.3 mg/kg (0.6-85.7 mg/kg). Complications occurred in 4/146 procedures. Clinical follow-up showed excellent response in 14/16 children with macrocystic LMs, 21/27 children with combined LMs and 4/7 children with microcystic LMs. Doxycycline is a safe and effective sclerosant agent for treating LMs in children, with a low complication rate.

Abstract No. 283: Concomitant use of endovenous laser and foamed sclerosant in treatment of lower limb varicosities: 5 year follow-up results

To assess long term results of concomitant use of two modes of treating varicose veins—endovenous laser treatment for Great Saphenous Vein (GSV) reflux and foam sclerotherapy for incompetent perforators and accessory venous channels. 186 diagnosed and symptomatic varicose veins patients (66 women,120 men; mean age 45.5yrs) were treated with concomitant use of endovenous laser (for incompetent GSV) and sclerotherapy (for incompetent perforators and accessory venous channels). 253 lower limbs (76 Left, 43 Right, 134 billateral) were treated. 10MHZ linear Ultrasound (US) probe was used to map GSV. A 0.035 inch J-Guidewire introduced in GSV via locally anaesthesised site in proximal leg. A 5F sheath was advanced over the guide wire, followed by insertion of 610μm laser fiber into sheath. Fiber tip at SFJ was confirmed by US. Following perivenous local anesthesia, laser energy was delivered intraluminally at 14W in continous mode. Fiber was uniformly withdrawn. Sclerosant mixed with air to produce foam,was introduced through needle in perforators and additional venous channels under US guidance. All patients were advised ibuprofen and class II full-thigh stocking for 1 week. Clinical and US follow-up was done at 1 week, 3 and 6 months, 1, 2, 3, and 5 years. 98% laser treated GSV remained ablated at 3 year follow up. 7 % limbs in first year and additional 3% limbs in next 2 years (i.e, 10 % limbs in 3 years) required more sclerotherapy session for new incompetent perforators. 5% of limbs required additional sclerotherapy sessions in 4th & 5th year (i.e 50% of those coming in first 3 years). Significance of this being that these 5% were amongst the 10% those required treatment in first 3 years. No complications were noted.90% patients complained of tightness along the course of treated GSV. Patients resumed routine activities immediately. Endovenous laser in treating GSV reflux has impressive results at 3 years. Few patients present with recurrent complains in follow-ups. Foam sclerotherapy is effective in dealing with perforators and accessory venous channels. It can be repeated safely when required. Concomitant use of both modes limits the need of subsequent procedure.

Endovenous Laser Ablation and Concomitant Foam Sclerotherapy: Experience in 504 Patients

To investigate the value of endovenous laser ablation (ELA) and concomitant ultrasound-guided foam sclerotherapy (USGFS) in patients with chronic venous insufficiency. During a 6-year period, concomitant USGFS of the varicose veins were performed in 504 out of 610 patients who underwent ELA for truncal or perforating vein insufficiency. In these 504 patients (944 legs; bilateral in 440 patients), the incompetent veins were greater saphenous vein in 615 legs, small saphenous vein in 118 veins, perforating veins in 42 legs, and a combination of these in 169 legs. In all patients, after ELA of the incompetent veins, USGFS was performed for the remaining varicosities with 1-3% polidocanol foam. Patients were followed up clinically and with color Doppler ultrasound at 1, 6, and 12months. ELA was technically successful in all cases, although another venous puncture was necessary in 29 legs. Concomitant USGFS was also technically successful in all cases, but one to three additional sclerotherapy sessions were performed in 203 legs with persistent varicosities. During the follow-up, recanalization of the laser-ablated refluxing veins occurred in 16 legs (1.7%) and was treated with repeat ELA or USGFS. Major complications occurred in 1.4% of the treated legs and included skin necrosis and calf vein thrombosis. ELA and concomitant foam sclerotherapy is feasible and effective. The procedures are associated with a low complication rate and can be performed in both legs in the same session. Concomitant use of laser and foam may potentially decrease the recanalization rate of laser-ablated vessels.

Percutaneous sclerotherapy of peripheral venous malformations in pediatric patients

To report the efficacy of percutaneous puncture and sclerosis using polidocanol in the treatment of venous malformations (VMs) in pediatric patients. Between March 2007 and February 2011, a series of 19 patients with VMs on the upper and lower extremities had undergone a total of 89 sessions of intralesional sclerotherapy using polidocanol. All the procedures were performed in an angiographic suite under general anesthesia in order to maintain sedation for facilitating the procedure. For each injection, approximately 1ml of 2% polidocanol was injected for each centimeter of the diameter of the lesion, with a maximum of 6ml. Injection of the sclerosant was guided by real-time sonography and fluoroscopy. After the treatment, the symptoms completely resolved in four patients (21%). Clinical symptoms, such as bulging and pain were improved in 12 out of 19 patients (63%). They remained unchanged in three patients (16%). During the procedures, no major complications were encountered. The minor complications (65%) encountered were swelling and pain after treatment which were resolved by taking NSAID within a few days. In pediatric patients, sonographically guided percutaneous puncture and fluoroscopically guided sclerosis using 2% polidocanol is effective, less invasive and safe for the treatment of VMs, with a high success rate and minimal complications.

Treatment of venous malformations with ethanolamine oleate: a descriptive study of 83 cases

To evaluate the outcome and complications of sclerotherapy with injection ethanolamine oleate for the treatment of venous malformations (VMs). Eighty-three patients' (39 males and 44 females) age ranging from 3 months to 21 years with 85 lesions were followed clinically for about 1 year following treatment with injection of ethanolamine oleate. The cases were enrolled between January 2006 and December 2009. The amount of ethanolamine oleate per treatment session ranged from 0.50 to 10 ml, and maximum dose was 0.40 ml per kg body weight. All patients were evaluated after 8 weeks of last injection session. All of the treatment sessions were performed on a day-case basis. Eighty-five lesions have under gone 201 sclerotherapy sessions with 39 requiring one, 27 requiring two and 19 lesions requiring more than two sessions. Sclerotherapy with ethanolamine oleate provided complete resolution of symptoms in 79 lesions and significant improvement of 6 lesions. There is no recurrence of studied patients. All patients experienced pain and swelling to a variable degree for short duration. Skin sloughed out in four patients which were healed spontaneously. No other complications were observed in our study. The treatment of VMs with injection ethanolamine oleate is safe and effective.

Single session of percutaneous alcohol sclerotherapy for the treatment of isolated draining intrahepatic biliary duct: case report in a 5 months-old pediatric liver transplant recipient.

The present paper describes the first reported successful use of a single session of percutaneous alcohol sclerotherapy for the treatment of an excluded segmental biliary duct in a five-month-old left lateral liver recipient. A concomitant stricture of the hepaticojejunostomy was also successfully treated using standard percutaneous balloon dilatation. The patient has remained in good general condition for the next 26 months.

Flexible Video-Endsocopic Injection Sclerotherapy for Second and Third Degree Internal Hemorrhoids

ABSTRACT Background and objectives: Bleeding from hemorrhoids is the commonest cause of rectal bleeding in adults. Injection sclerotherapy of internal hemorrhoids is one of the non-surgical treatments, and is simple, safe and feasible. Conventionally sclerotherapy is performed with rigid proctoscope which has limitations of maneuverability, narrower field of vision and documentation compared to flexible videoendoscope. Therefore, we assessed the efficacy and safety of video-colonoscopic sclerotherapy for bleeding internal hemorrhides. Methods: Seventy-nine patients of bleeding internal hemorrhoids were subjected to colonoscopic sclerotherapy using 1.5% polidocanol in retroflexed or forward viewing positions. Success of treatment was defined as cessation of bleeding for six weeks. Patients were observed for complications and were followed up regularly for 3 months. Results: A total of 79 evaluable patients, 61 had grade II and 18 had grade III hemorrhoids. There was no statistically significant differences in achieving excellent or good results for control of bleeding between patients with grade II and grade III hemorrhoids (100% vs 94,5%; p>0.05). The number of sessions of sclerotherapy required were significantly more in grade II than grade III hemorrhoids (1.1 ± 0.3 vs 1.3 ± 0.7; p = 0.04). No significant complications were noted except for bloating in ten patients (12.6 %) and rectal pain in 6 (7.6%) patients. Median time taken for the procedure was 30 minutes. Conclusions: Video-endoscopic sclerotherapy is safe, well-tolerated and effective treatment for bleeding internal hemorrhoids.(J Dig Endosc 2011;2(1):1-5)

Retrospective analysis of facial paralysis caused by ethanol sclerotherapy for facial venous malformation

Absolute ethanol sclerotherapy provides a reliable treatment for facial venous malformation, although facial nerve injury may occur after sclerotherapy. This study is a retrospective review of facial nerve dysfunction after sclerotherapy. A total of 91 patients with facial venous malformations accepted 288 ethanol sclerotherapy sessions. The facial nerve dysfunctions caused by the therapy were evaluated and analyzed. There were 9 instances of facial nerve injury. For 18 sessions of sclerotherapy in the temporal region, 5.6% of patients experienced injury to the temporal branch; for 12 sessions in the zygomatic region, 41.7% of patients experienced injury to the zygomatic branch. After patients were treated with medication, 8 of 9 instances of nerve injury recovered. The zygomatic and temporal branches of the facial nerve were the most vulnerable to injury after ethanol sclerotherapy. Surgeons are thus called on to pay more attention when performing ethanol sclerotherapy in those areas.

Invited commentary

Invited commentary

Ethanol threshold doses for systemic complications during sclerotherapy of superficial venous malformations: a retrospective study

Ethanol has been used for many years for superficial venous malformations (VM) sclerotherapy. Although ethanol is well-tolerated in most of the cases, systemic side effects have been reported in some patients, including cardiac collapse and death. Systemic toxic side effects have been suspected to be proportional to the ratio of ethanol dose divided by the patient's body weight (dose/weight ratio in millilitre per kilogram). No extensive study has yet been conducted to determine the toxic threshold, and no consensus exists on this point. We retrospectively studied the systemic effects of ethanol sclerotherapy in a consecutive series of 71 patients with VM. Seventy-one consecutive patients with VMs were treated by ethanol sclerotherapy and 162 procedures were performed. The only factor significantly associated with a systemic adverse event was the ethanol dose/weight ratio per intervention. The ethanol dose/weight ratio superior to 0.24 ml/kg was predictive of systemic toxic effects, suggesting a limit dose for ethanol sclerotherapy of VM. Systematic complications were not related to repetitive sclerotherapy sessions. Based on our findings, a maximal ethanol dose/weight ratio of 0.2 ml/kg could be considered as acceptable in VM treatment indications.

Foam sclerotherapy of the great saphenous vein with sapheno-femoral ligation compared to standard stripping: a prospective randomized controlled trial

to compare the clinical outcome of foam sclerotherapy of the great saphenous vein (GSV) combined with sapheno-femoral junction (SFJ) ligation to standard stripping surgery. as a prospective randomized controlled trial, 60 consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups, treated by SFJ ligation and either foam sclerotherapy or standard stripping of the GSV. There were 26 male and 34 female with a median age of 49 years (ranging 37 to 66 years). Primary end points were patient recovery period, postoperative pain, quality of life and recurrence rate. Secondary end points were frequency of complications on the two arms of the trial. all treatments were completed as intended. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group than the standard stripping (43 min vs. 65 min, P < 0.01). Less analgesic use postoperatively was recorded in the foam sclerotherapy group. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group compared to the surgical group (3 d vs. 6 d, P < 0.01). After 3 months, median CEAP class dropped from four pre-operatively to one following treatment in both groups (P < 0.01). After 6 months, in the foam sclerotherapy group, 5 patients needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 80.0%. And the short-term obliteration rate was 89.5% in the conventional surgery group. foam sclerotherapy combined with sapheno-femoral ligation involves a shorter treatment time, less postoperative discomfort and results in more rapid recovery compared to conventional GSV stripping.

Techniques and curative effects of fluoroscopy-guided foam sclerotherapy for lower extremity varicosities

Objective To describe the techniques of fluoroscopy-guided foam sclerotherapy for lower extremity varicosities, and evaluate the feasibility, safety and curative effects of it. Methods From October 2008 to December 2009, a total of 21 legs in 16 patients with lower extremity varicosities received radiological-guided foam sclerotherapy. They were enrolled in this study. Sodium morrhuate was foamed with by the filling-defects technique under fluoroscopy guidance. Postoperative compression was maintained for 2 weeks. Clinical effect was assessed as full success, partial success and no success. Complications were classified as minor or serious. Results The technical procedure was successful in all foam sclerotherapies for 21 legs. And, a single sclerotherapy session was adequate for all legs. The median follow-up period was 6. 0 months after treatment, ranged from 3.0 to 17.0 months. In this period, Clinical effect was assessed as full success for 17 legs (81.0%) and partial success for 4 legs ( 19.0% ). All patients presented selflimiting minor complications, including cordlike subcutaneous indurations along the treated veins (21 cases), skin hyperpigmentation in 11 legs (8 cases), local pain in 7 legs (6 cases) and superficial thrombophlebitits in one leg ( 1 case). No serious complications or systemic events occurred. Conclusion Fluoroscopy-guided foam sclerotherapy was a feasible, safe and effective treatment for lower extremity varicosities. Key words: Lower extremity; Varicose veins; Embolization, therapeutic; Radiology,interventional; Foam sclerotherapy

Combination of Oral Corticosteroids and Polidocanol Sclerotherapy in the Management of Infantile Hemangiomas

Infantile hemangiomas (IHs) are the most common benign tumors of infancy and may need to be treated in some cases. Oral corticosteroids are the mainstay of therapy but are not without their attendant side effects. To evaluate the efficacy of combination therapy with oral corticosteroids and polidocanol sclerotherapy in hemangiomas needing treatment. Eight children with IHs were started on oral prednisolone 3 to 4 mg/kg per day and fortnightly sclerotherapy with 3% polidocanol solution. The outcome was evaluated on the basis of color, turgidity of the lesion, ongoing growth, and assessment by parents and physician. Serial photographic records were maintained. The response was graded as excellent, good, poor, or nil. Complications were recorded. Four male and four female patients presented at a mean age of 4.6 months. The average area of the lesions was 40.6 cm(2) . The mean duration of treatment with steroids at full dose was 8.2 weeks and mean total duration of treatment was 28.6 weeks. Mean number of sclerotherapy sessions required was 4.7. Complications included ischemic necrosis, rebound growth, and ulceration. Combining oral corticosteroids with polidocanol sclerotherapy produced excellent results in the patients treated, with minimal attendant side effects.

Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts

The authors sought to evaluate the effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy in treating endometrial cysts and adopt this procedure as an alternative to surgery. Fifty consecutive patients with an average age of 25.2 years [standard deviation (SD) 6.5; range 16-40 years) and US diagnosis of endometrial cyst who were pregnant or presenting with high anaesthesia risk, adhesions or who refused surgery underwent US-guided aspiration of a total of 54 endometrial cysts (40 with transabdominal approach and the remaining 14 with transvaginal approach) and ethanol sclerotherapy. The procedure was successful in all patients. Follow-up imaging was carried out at 12 h, 24 h, 15 days, 3 months, 6 months and 12 months. After 12 months, four patients (8%) showed recurrence, three of whom opted for a second session of US-guided aspiration and ethanol sclerotherapy. US-guided aspiration and sclerotherapy with 95% ethanol provides a valid alternative to surgery in treating endometrial cysts.

Digital Subtraction Angiography-Guided Percutaneous Sclerotherapy of Venous Malformations With Pingyangmycin and/or Absolute Ethanol in the Maxillofacial Region

The present study evaluated the safety and efficacy of digital subtraction angiography-guided percutaneous sclerotherapy of venous malformations (VMs) with pingyangmycin and/or absolute ethanol in the maxillofacial region. We present our safe and novel method for treating venous malformations. A total of 20 patients (21 locations) diagnosed with VMs were enrolled in the present trial. Evaluated by preoperative digital subtraction angiography, the lesions were categorized into 4 types according to the venous drainage features. Of the 20 patients, 5 had type I VMs, 5 had type II, 6 had type III and 3 had type IV VMs. One patient had type I and type III VMs in different locations of the maxillofacial region. For types I and II lesions, pingyangmycin sclerotherapy was performed. Multistage sclerotherapy with absolute ethanol and pingyangmycin was performed on types III and IV lesions. After evaluation and guided by preoperative digital subtraction angiography, all the patients were treated successfully and safely. Of the 20 patients, the clinical outcome was excellent in 13, good in 6, and fair in 1. No disease recurrence was noted during the follow-up evaluations (range 6 to 25 months, median 13.55). The complications were fever in 5 patients after the first session of sclerotherapy, incomplete facial paralysis in 1, swelling in 1, and ulceration in 3. No major complications were observed. Digital subtraction angiography-guided phlebography of VMs in the maxillofacial region is one of the approaches to classify VMs using anatomic and hemodynamic features. A strong association was seen between the type of VM and the approach of sclerotherapy. Percutaneous sclerotherapy using pingyangmycin and/or absolute ethanol is a safe and effective method of treating symptomatic VMs.

Abstract No. 182: Treatment of lower limb varicosities with combined use of endovenous laser and sclerosant at the same instance - A unique study of 286 patients

To report short term results of combining two modes of treating varicose veins - endovenous laser treatment for Great Saphenous Vein(GSV)reflux and sclerotherapy for incompetent perforators and accessory venous channels. 186 diagnosed and symptomatic varicose veins patients (66 women, 120 men; mean age 45.5 yrs) were treated with endovenous laser (for incompetent GSV) and sclerotherapy (for incompetent perforators and accessory venous channels). 253 lower limbs (76 left, 43 right, 134 billateral) were treated. 15 patients (18 legs; 7%) had ulcers. 7 patients (9 legs) had associated saphenopopliteal reflux. 10 MHZ linear Ultrasound (US) probe was used to map GSV. A 0.035 inch J-Guidewire introduced in GSV via locally anaesthesised site in proximal leg. A 5F sheath was advacned over the guide wire. A 610 μm laser fiber was inserted into sheath, and its tip placed at SFJ, location confirmed by US. Following perivenous local anesthesia, laser energy was delivered intraluminally at 14W in continous mode. Fibre was uniformly withdrawn. Sclerosant mixed with air to produce foam, was introduced through needle in perforators and additional venous channels under US guidance. All patients were advised ibuprofen and class II full-thigh stocking for 1 week. Clinical and US follow-up was done at 1 week, 3, 6 and 12 months. Criteria for successful treatment were US features (on day 7) of noncompressible GSV with reduced calibre and thick echogenic walls, and no colour flow within it. Primary failure was defined as failure to occlude or recanalised GSV lumen along with presence of reflux. 98% GSV were ablated initally. Rest underwent successful second sitting.7% limbs required one more session of sclerotherapy for new incompetent perforators. No DVT, nerve injury or skin burns were noted. 90% patients complained of tightness along the course of treated GSV. All non-healing ulcers responded well. Patients resumed routine activities immediately. Sclerotherapy is effective in dealing with perforators and provides rapid healing of chronic venous ulcers. Laser at the same time is effective in dealing with GSV reflux. Sclerotherapy and laser together demonstrate better outcome, limiting need of any subsequent procedure.

Sclerotherapy of benign oral vascular lesion with sodium tetradecyl sulfate: cases report

Hemangioma and vascular malformation is a common vascular benign lesion in the head and neck region. The lesion is a congenital malformation observed in neonates. The treatment this lesion includes surgical excision, cryotherapy, selective embolization and treatment w ith sclerotic agents. We present three cases of benign oral vascular lesions treated with an intralesional injection of sodium tetradecyl sulfate. Th e lesions virtually dis- appeared after three sessions of sclerotherapy, leaving an inconspicuous scar. No side effects were observed. Sclerotherapy wit h sodium tetradecyl sulfate is effective in treating benign oral vascular lesions, and the use of the sodium tetradecyl sulfate provides alternativ e or support for surgical methods.

Percutaneous Sclerotherapy for Facial Venous Malformations: Subjective Clinical and Objective MR Imaging Follow-Up Results

Venous malformations are the most common of all vascular anomalies, 40% of which are found in the head and neck. We discuss results of percutaneous sclerotherapy using bleomycin for facial VMs by using subjective clinical assessment and objective changes on MR imaging. Thirty-seven patients with facial VMs were treated by percutaneous sclerotherapy with bleomycin. Of these, 31 patients with 32 lesions had pre- and posttreatment MR imaging. Each lesion received between 1 and 9 sclerotherapy sessions (average, 3.5). MR findings and clinical results of treatment were retrospectively reviewed. Clinical results were based on the physician's physical examination and interview of the patient; these were classified as worse, unchanged, or better. Objective results on MR imaging were classified as worse, no change, minor improvement (<50% decrease in size), marked improvement (>or=50% decrease), or cure. Objective and subjective results were compared. Twenty-one lesions showed objective improvement on MR imaging. Of these, 10 showed minor decrease in size and 11 showed marked decrease. Eleven lesions showed no change on MR imaging. No VMs were worse or completely cured. Subjectively, 29 patients and 30 clinicians thought that lesions improved. Four of 32 (12.5%) patients suffered minor transient complications. Percutaneous sclerotherapy by using bleomycin is a safe technique to objectively decrease size and subjectively alleviate symptoms of facial VMs. Subjective clinical improvement is not always associated with visual size reduction on MR imaging. Minimal size reduction or partial fibrosis of the lesion may be enough to achieve subjective clinical improvement.

Intramural esophageal hematoma after elective injection sclerotherapy

Although endoscopic esophageal variceal sclerotherapy has been largely supplanted by variceal band ligation, it is still performed routinely in many institutions, especially in developing countries. Intramural esophageal hematoma has been described as a rare complication of sclerotherapy. Risk factors have not been completely established. To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the possible factors involved. This is a retrospective observational study made at the 'Hospital Universitário Clementino Fraga Filho', Rio de Janeiro, RJ, Brazil, reviewing the medical records of all esophageal variceal sclerotherapy procedures performed from April 2000 to November 2005. The evaluation of the clinical, laboratorial and endoscopic features in our patients and those reported in the literature was also done. Review of literature was performed through MEDLINE search. A total of 1,433 esophageal variceal sclerotherapy procedures were performed in 397 patients, with an intramural esophageal hematoma incidence of 4 cases (0.28%). Three of our patients developed additional complications, and one death was a direct consequence of a rupture of the hematoma. Nineteen well described cases were reported in the literature. Intramural esophageal hematoma occurred mostly after the forth esophageal variceal sclerotherapy session. Coagulation disturbances were present in the majority of cases. Intramural esophageal hematoma is a rare complication of esophageal variceal sclerotherapy and its incidence in our institution was similar to those observed in the literature. Our study suggests that this complication occurs as a result of a fragile esophageal mucosa after previous esophageal variceal sclerotherapy sessions. Impaired coagulation, although not essential, could contribute to hematoma formation and extension through esophageal submucosa.

Craniofacial Venous Malformations: Magnetic Resonance Imaging Features That Predict Treatment Outcome

Craniofacial venous malformations (VMs) are challenging lesions. Treatment is not routinely indicated unless the benefit and loss have been weighed properly. Therefore it is crucial to predict clinical outcome before treatment. This study was performed to retrospectively determine whether pretreatment magnetic resonance imaging (MRI) findings are predictive of outcome in patients who undergo sclerotherapy for craniofacial VMs. MRI findings and clinical results of percutaneous sclerotherapy with ethanol and bleomycin A(5) in 69 patients with craniofacial VMs were retrospectively reviewed. Lesions were categorized with MRI based on margins; 51 were limited VMs, and 18 were infiltrating VMs. We performed t test analysis to assess the difference in the number of sclerotherapy sessions between the 2 groups. The Kruskal-Wallis test was used to evaluate differences in symptom improvement and satisfaction level between the groups. The difference in complication rates was assessed by chi(2) analysis. The better response to treatment was among the patients with limited VMs. The number of sclerotherapy sessions was 1.9 +/- 1.2 for limited VMs and 3.6 +/- 1.5 for infiltrating VMs, with a significant difference between the groups (P = .0001). The patients with limited VMs were significantly more likely to have better symptom improvement (P = .0001) and a higher satisfaction level (P = .0001). The complication rates of the limited and infiltrating VMs were 18.2% (18/99) and 32.8% (21/64), respectively. A significant difference was found between the groups (P = .033). The feature of lesion margin on MRI before sclerotherapy is an important predictor of treatment outcome for craniofacial VMs.