Treatment Of Venous Malformations Research Articles

A Step‐Ladder Protocol to Treat Cervico‐facial Venous Malformations

Objectives: Venous malformations (VMs) are the most commonly encountered vascular malformation of the cervico-facial region. Their clinical spectrum is extremely variable as they can present as single small lesions (often confined within muscle fasciae) or huge infiltrating ones. They can be part of a syndrome, as with Bean Syndrome, or in cutaneous mucosal venous malformation syndrome, among others. The aims of the study were: (1) Diagnose and stage a cervico-facial VM. (2) Describe the available treatment for head and neck VMs. (3) Propose the most appropriate treatment based on the staging of the VM. Methods: A review of the pertinent literature was performed to provide the common indications and techniques to treat head and neck VMs. Thirty-four consecutive cases of VMs have been treated by the authors by means of endovascular sclerotherapy with sodium tetradecyl sulphate, surgery, or both. Only patients with intraosseous VMs (8 total) were treated by surgery alone. Three large, unresectable cervicofacial VMs were treated by means of the “strangling technique.” Results: Good to very good aesthetic and functional results were obtained in all 34 patients. All 26 patients who underwent sclerotherapy experienced significant swelling. Six cases of skin or mucosal ulcerations were noted. No damage to the facial nerve was observed. Five patients affected by larger VMs showed partial recanalization/recurrence of the malformation. Conclusions: Cervicofacial VMs have to be managed by an experienced, multidisciplinary team. A protocol with increasing invasiveness is proposed to maximize results after their treatment.

Aspirin therapy in venous malformation: a retrospective cohort study of benefits, side effects, and patient experiences.

Venous malformations (VMs) are often painful and may enlarge over time. Chronic coagulopathy is common in VMs and may contribute to phleboliths and potentially to disease progression. Few studies have examined the effects of anticoagulation on VMs and to our knowledge none have examined the use of aspirin therapy. A survey was administered to patients and parents of patients with VMs who attended the University of California at San Francisco Vascular Anomalies Center over a 4-year period (2008-2012) to whom aspirin had been recommended. They were surveyed regarding whether they were taking aspirin and, if yes, whether aspirin had resulted in any appreciable benefit. Sixty-five letters were sent to potential subjects: 38 participated and 27 declined to participate or could not be contacted. Twenty-eight of the 38 had begun aspirin and 22 reported current use. Seventeen reported some benefit, including less aching (n = 2), less shooting pain (n = 15), less fullness and swelling (n = 13), and shrinking of the VM (n = 1). Discontinuation of aspirin was associated with worsening VM symptoms in five of six patients. Side effects were reported in 6 of 28 patients, including five episodes of minor bleeding or excessive bruising and one of nausea and vomiting. This study suggests that aspirin may be a beneficial treatment for VM, with a reduction in pain and soft tissue swelling and an acceptable side-effect profile, but the retrospective nature of the study and the small size of the cohort limited our conclusions. Larger prospective studies of aspirin for VM using clinical and laboratory outcome measures are needed to confirm these observations.

Effectiveness of Sclerotherapy, Surgery, and Laser Therapy in Patients With Venous Malformations: A Systematic Review

Because the best possible treatment for venous malformations is unclear, this study systematically reviews the available literature regarding the effectiveness of different treatment options for the patient group. Venous malformations result from incorrect development of the veins during embryogenesis and are present at birth. Venous malformations may exhibit symptoms, such as pain, swelling, and inflammation of the vessel. A systematic literature search in PubMed and Embase was performed. Data regarding the design, participants, intervention and, treatment outcome (success and complications) were extracted. The validity of the studies was assessed with the Cochrane Collaboration's risk of bias tool. Thirty-five studies were identified studying the effectiveness of eight treatments: sclerotherapy/embolization with ethanol, gelified ethanol, bleomycin, polidocanol, sodium tetradecyl sulfate (STS), Ethibloc, surgery, and laser therapy. All of the included studies have a high or unclear risk of bias. The average biased reported success rates for ethanol, gelified ethanol, bleomycin, polidocanol, STS, Ethibloc, surgery, and laser therapy were 74, 89, 88, 90, 86, 65, 90, and 94%, respectively. Until more valid evidence is available, the choice for treatment remains a shared decision between the patient and a multidisciplinary treatment group. From a cost perspective, sclerotherapy with STS or polidocanol should be the treatment of choice.

Surgical treatment for venous malformation

Sclerotherapy is generally the preferred treatment for venous malformation (VM) with surgery usually playing an adjunctive role. This study presents our experience with surgical treatment of VMs. Consecutive patients were identified from our vascular anomalies database 1996-2011 and patient demographics, location of the lesion, type of tissue(s) affected and symptoms were analysed. The patients completed a questionnaire to assess the impact of surgery on the severity of symptoms, appearance, function and overall quality of life (QoL), using a visual analogue scale of 0 (no symptom) to 10 (maximal symptom). They also rated their overall satisfaction of treatment using a scale of 0 (complete dissatisfaction) to 10 (complete satisfaction). Fifty patients with VM underwent a total of 58 procedures. Complication occurred in six patients (9.7% of operations), including transient sensory loss (n=3) and permanent frontal branch palsy (n=1), haematoma formation (n=1) and minor wound dehiscence (n=1). At least 50% improvement in symptoms of background pain, acute episodic pain, contour deformity and skin discolouration occurred in 88.9%, 92.3%, 83.3% and 75.0% of patients, respectively. At least 50% improvement in the appearance, function and overall QoL occurred in 54.3%, 71.4% and 70.4% of patients, respectively. The mean overall patient satisfaction with the treatment was 8.9 (range, 1-10). Surgery remains an important treatment modality for selected patients with VM having low complication rates and high patient satisfaction. It improves the appearance, function and overall QoL for the majority of the patients by reducing the severity of pain, contour deformity and skin discolouration.

Treatment strategies for large oral venous malformations using intralesional laser photocoagulation

We report two treatment strategies using intralesional laser photocoagulation (ILP) for large venous malformations (VMs) in the oral cavity. ILP is considered to be an effective technique for massive vascular lesion. The satisfactory results could have been obtained, since we started ILP for the treatment of large VMs. Recently, to improve the safety, reliability, and effectiveness of the treatment, we developed modifications of ILP that include a combination of ILP and transmucosal irradiation; and compartmentalization and serial step irradiation. In the former, ILP is performed for a deep layer lesion and transmucosal irradiation with multiple spots fashioned using a single pulse is added for the superficial layer in the same session, to increase the efficacy of regression. In the latter, the lesion is divided by virtual compartment and each area will be sequentially treated by ILP. The irradiated area and total energy in a session should be limited to avoid severe reactions and excessive thermal destruction of surrounding tissue. All treatment outcomes by each technique were satisfactory without serious complications, such as deep ulcer formation, bleeding, or severe swelling developing obstruction. Both treatment strategies improve the safety, reliability, and effectiveness of ILP and make the method less traumatic for patients.

2:26 PM Abstract No. 41 - Percutaneous sclerotherapy of venous malformations: efficacy and safety of ethanol and sotradecol

Purpose Venous Malformations are the most common type of vascular malformation in adults, effecting 1-4% of the population; however, the treatment options are relatively limited. Percutaneous sclerotherapy is considered a first line treatment for symptomatic lesions. The purpose of this study is to review the safety and efficacy of ethanol and sotradecol in the treatment of venous malformations. Materials and Methods A retrospective analysis was performed of all patients with venous malformations from 1/1/2000 - 9/1/2012. Lesions were targeted with ultrasound and/or fluoroscopic guidance and venography was then performed through the access needle(s). Venous drainage of the malformation was isolated with a tourniquet and/or direct compression of non target venous structures. The sclerosing agent was then injected to the volume of the lesion as determined on venography. Technical success was defined as the ability to access the lesion, isolate it from non target vessels and deliver the sclerosant. Ethanol or sotradecol were chosen at the operators’ discretion. Lesions in high risk locations (face, hands) were treated preferentially with sotradecol. All patients were followed in IR clinic to asses for response to treatment and complications. Results A total of 186 treatments (136 ethanol, 50 sotradecol) were performed on 95 patients with ages ranging from 9 - 75 (median 30.4). Technical success was 95%. Number of treatment sessions ranged from 1-17 (mean 1.96). Clinical follow up was obtained in 88% of patients. Complete, partial and no relief of symptoms was seen in 35%, 57%, 8% of total treatments; 43%, 48%, 9% of ethanol treatment sessions; and 16%, 80%, 4 % of sotradecol treatment sessions. Complications were seen following 3.7% of ethanol treatment sessions and 2.0% sotradecol treatments. Only complete symptomatic relief (44% vs 18%) was significantly different between the two groups (p=0.0017). Conclusion Percutaneous sclerotherapy of venous malformations is safe. Ethanol and sotradecol are effective agents. In this series, complete symptomatic relief was higher for ethanol than sotradecol. This may reflect significant selection bias as sotradecol is used for lesions in more challenging anatomic locations.

Management of venous malformations with percutaneous radiofrequency thermal ablation

Multiple treatment options exist for venous malformations (VMs), but each treatment has its own deficiencies. Radiofrequency ablation (RFA) is an emerging technology which may be an effective new technique for treatment of VMs. To study the effect of RFA on VMs. We reviewed patients treated with RFA for VM followed by a blinded retrospective analysis of serial photographs taken during the course of their therapy. Questionnaires were used to evaluate perceived therapeutic response and complications of this treatment. Sixteen patients with complete data and photographic documentation were involved in this study. Complete resolution (> 90%) was obtained in two patients. Significant improvement (75-90%) of the treated lesion occurred in eight patients. Moderate improvement (50-75%) was obtained in one patient and little improvement in three patients. Two patients had no response. Most VMs improved, with a mean ± SD size change score of 2·6 ± 1·3 and overall score of 5·1 ± 2·4. No serious complication was observed in any of our patients and no evidence of recurrence was observed in any case. Percutaneous RFA, as a minimally invasive and safe treatment, may provide an alternative treatment for VM and other skin diseases. There should be a randomized trial undertaken, comparing RFA with other treatments, to assess outcome.

Comparative study of sclerotherapy of venous malformation in children using absolute ethanol and pingyangmycin

Objective To evaluate and compare the curative effect and the safety of sclerotherapy of venous malformation in children using absolute ethanol and pingyangmycin.Methods Eighty children with venous malformation were treated by sclerotherapy with absolute ethanol or pingyangmycin under general anesthesia during February of 2009 to May of 2011. Diagnostic criteria included the presence of a bluecolored lesion at birth,with gradual increase in its size associated with a positive postural test.MRI showed characteristic imaging features.Eighty patients were divided into two groups by randomization.Forty patients were treated with absolute ethanol,and the remaining 40 patients with pingyangmycin. The therapeutic effects and side effects were observed and recorded during a follow-up period of 6 to 24 months ( average 15 months).Treatment results were divided into four categories: cure, basic cure, effective, and ineffective,and the former three categories were considered effective in treatment.Chi-square test was used to compare the rate of effective treatment and rate of complications in these two groups.Results The effective patients treated with absolute ethanol was 38 (95.0％,38/40),and the effective patients with pingyangmycin was 26(65.0％,26/40),x2 test ( x2 =11.25,P ＜ 0.01 ) difference was statistically significant.Eight patients developed skin necrosis; 4 patients serious local swelling,2 patients muscle fibrosis,1 patient cerebral embolism in the absolute alcohol group.Two patients developed postoperative fever and vomiting and 2 skin necrosis in the pingyangmycin group,the difference was statistically significant (x2 =12.29,P ＜0.01 ). Conclusions Sclerotherapy is effective for the treatment of venous malformations in children.Absolute ethanol is more effective,but associated with more complications,such as skin necrosis or as serious as cerebral embolism,than pingyangmycin. Key words: Child ; Hemangioma ; Sclerotherapy ; Sclerosing solutions ; Ethanol ; Bleomycin A5

Venous Malformation

Venous malformations (VMs) can cause significant morbidity, particularly because they enlarge over time and become symptomatic. The purpose of this study was to determine the natural progression of VMs to facilitate patient counseling, gain insight into pathophysiology, and guide therapy. Our Vascular Anomalies Center database was reviewed for patients with cutaneous and soft-tissue VMs. Predictive variables were age, gender, location, pregnancy, and size. The outcome variable was natural progression of the malformation defined by expansion of the lesion or the onset/worsening of symptoms. The study included 614 patients. Children had a 26.1% risk of progression prior to adolescence, 74.9% before adulthood, and 93.2% over their lifetime. Progression was more likely in adolescence (60.9%) than in childhood (22.5%); the relative risk was 2.6 (95% confidence interval, 2.1-3.2) (P = 0.0001). Diffuse VMs progressed more often than localized lesions (P = 0.002); extremity and trunk VMs worsened more frequently than head/neck lesions (P = 0.03). VMs have a higher risk of progression in adolescents than in children; pubertal hormones may contribute to expansion. Because of their high rate of progression, early treatment of asymptomatic VMs should be considered.

Low flow vascular malformation of the buccal mucosa treated conservatively by sclerotherapy (3% sodium tetradecyl sulfate)

Vascular anomalies constitute some of the most difficult diagnostic and therapeutic enigmas in the head and neck region. It is of paramount importance that a modern classification system is established to differentiate vascular lesions from vascular malformations. Vascular malformations are usually congenital and venous anomalies usually expand because of hormonal changes such as puberty, pregnancy, or secondary to trauma. Here, we report a case which was diagnosed as low flow vascular malformation of buccal mucosa involving the lower lip and subsequently treated with 3% sodium tetra decyl sulfate. This paper provides overall understanding regarding the presentation and management of small vascular lesions in the orofacial region. Percutaneous sodium tetradecyl sulfate when used either alone or as adjunct to surgery is a safe, effective, and inexpensive agent in the treatment of venous malformations. However, proper case selection, evaluation, and careful planning are necessary to reduce the unwarranted risks and complications.

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.

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.

Die intraläsionale Sklerosierung venöser Malformationen an der Hand mit Natriumtetradecylsulfat

Congenital venous malformations (VM) at the hand are rare. VM consist of dysplastic venous vessels without progressive cellular proliferation. The therapy for VM is considerably different from that for vascular tumours (e. g., haemangiomas). Treatment options for vascular malformations are antithrombotic medication, local compression, resection of the VM, and obliteration of the lumina by percutaneous sclerosation. Here, the percutaneous sclerosation for the treatment of VM with sodium tetradecyl sulfate has been illustrated and discussed on the basis of 2 case reports.

Abstract No. 44: The role of cone beam CT in the treatment of venous malformations and prediction of local skin complications

Abstract No. 44: The role of cone beam CT in the treatment of venous malformations and prediction of local skin 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.

A clinical study of ultrasound-guided intralesional injection of bleomycin A5 on venous malformation in cervical-facial region in China

To evaluate the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin A5 on treatment of venous malformation (VM) in cervical-facial region. Seventy-five patients (32 male, 43 female), ranging in age from 13 to 60 years old, suffering from VM in cervical-facial region were admitted to and treated at our hospital between June 2006 and February 2007. Of all the patients, 54 malformations were located in the facial region, eight in the submental region, 10 in the submandible region, and three in the cervical region; all were treated by ultrasound-guided intralesional injections of bleomycin A5. The size of the lesions ranged from 6 x 9 mm to 32 x 39 mm. Injection of bleomycin A5 on venous malformation was then carried out through the inspection of ultrasonography. Repeated course of bleomycin A5 injection was administrated for larger malformations. The amount was 8 mg each time. The therapeutic interval was two to four weeks. The therapeutic outcome on venous malformation was evaluated by physical examination and ultrasonography with Doppler according to the Shou standards, including four grades; cured, basically cured, improved, and invalid. The complications were also observed during and after injection. The duration of follow-up ranged from 6 to 24 months. The average times of treatment were 1.64 times. Among them, 42 patients (56%) received only one time of treatment, 21 (28%) patients received two times, nine (12%) patients received three times, and three (4%) patients received four times. According to criteria of therapeutic outcome, the results showed cured in 63 patients (84%), basically cured in 10 patients (13.33%), improved in two patients (2.67%), and none ineffective. Seventy-one patients (94.67%) had local swelling in injection region for several days and two patients (2.67%) developed temporary dizziness after treatment. There were no other complications recorded. Intralesional injection of bleomycin A5 establishes a promisingly effect way for patients suffering from VM in the cervical-facial region under ultrasound guidance.

Intralesional sclerotherapy for subcutaneous venous malformations in children

Venous malformations (VMs) involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult. Recently sclerotherapy has been suggested as the primary treatment for VMs instead of surgical intervention. This report represents eight cases of children with VMs treated with direct percutaneous injections of sclerosing agents, such as ethanol, polidocanol or ethanolamine oleate. All eight patients had large lesions (>3 cm) located on the head, foot, neck and face. Sclerotherapy was performed in an angiographic suite under general anesthesia. Prior to sclerotherapy, percutaneous phlebography was performed in order to visualize the dynamic situation inside the lesion and the draining flow into the adjacent venous vascular system. A 2-15 ml of sclerosing agent was injected into VM lesions under fluoroscopy. An evaluation by MRI examination showed that 6 out of 8 patients had remission, and alleviation of their symptoms without major complications, furthermore one of the lesions apparently disappeared. Intralesional sclerotherapy provides a simple, safe and effective treatment for VMs in the subcutaneous lesions in children.

Predictors of response to percutaneous ethanol sclerotherapy (PES) in patients with venous malformations: Analysis of patient self-assessment and imaging

Percutaneous ethanol sclerotherapy (PES) is the primary tool in the treatment of venous malformations (VM). However, PES has known serious complications. This study is aimed at identifying predictors of good response to PES in patients with VM to improve patient selection. We performed a retrospective, cross-sectional study of 158 VM patients (mean age, 14.3 years, male 42%) who underwent ethanol sclerotherapy at a specialized vascular malformation center. For clinical result assessment, patients or parents in pediatric patients answered questions on symptomatic, functional, and cosmetic improvement after PES. In each category, the possible choices were markedly improved, moderately improved, no change, moderately worse, or markedly worse compared with pretreatment status. A "good response" was defined as one or more areas of marked improvement on the self-assessment in conjunction with marked improvement on post-treatment images (> or =30% decrease in maximal diameter of VM on magnetic resonance imaging [MRI] or > or =50% decrease in abnormal blood pool ratio on whole body blood pool scintigraphy [WBBPS] compared with pretreatment images). To determine predictors of a good response to PES, uni- and multivariate analysis were conducted on demographics (age, gender), clinical features of VM (location, size, depth of involved tissue, presence of associated lymphatic malformation, MRI findings; well-defined vs ill-defined margin, characteristics of venous drainage during PES) and treatment variables (number of PES sessions, maximal concentration and dosage of ethanol used in PES, adjuvant therapy). Symptomatic, functional, and cosmetic improvement was 28%, 27%, and 34%, respectively, based on patient questionnaires. Based on imaging studies, 42 patients (27%) had markedly improvement. Composite outcome combining questionnaire results and imaging study showed that 16% of patients had a "good response". On multivariate analysis, female gender (odds ratio [OR]: 4.49, 95% confidence interval [CI]: 1.24-16.28), no or delayed visualization of drainage vein (OR: 9.22, 95% CI: 1.79-47.51), and a well-defined margin on MRI (OR: 13.38, 95% CI: 2.84-63.12) were independent predictors of "good response" to PES. PES should be performed in selected patients in order to obtain the best outcomes and minimize complications. No or delayed visualization of drainage vein on initial direct puncture venogram, a well-defined margin on MRI, and female gender were statistically significant predictors of a "good response" to PES and may be useful in selecting patients.

MR Imaging–guided Percutaneous Sclerotherapy of Peripheral Venous Malformations with a Clinical 1.5-T Unit: A Pilot Study

To evaluate the feasibility of magnetic resonance (MR) imaging-guided percutaneous sclerotherapy of venous malformations (VMs) by using a clinical 1.5-T MR unit and the safety and therapeutic outcome of the performed procedures. This is a prospective pilot study with ethical approval and written informed patient consent. Ten MR imaging-guided percutaneous sclerotherapy treatments were performed in 10 patients (one male and nine female patients; age range, 16-47 years; mean age, 30.3 years) with a VM in the foot and/or ankle (n = 5), calf (n = 2), thigh and/or knee (n = 2), and elbow (n = 1). MR imaging was used for needle insertion guidance and real-time monitoring of the injection process by using three-dimensional fast spoiled gradient-echo MR sequences (repetition time msec/echo time msec = 3.7-5.2/1.1-1.6, flip angle = 35 degrees) and meglumine gadoterate/ethanol solutions as the sclerosing agent. The technical success (ie, absence of technical problems, number of needle position corrections) was systematically evaluated along with safety aspects (ie, absence of complications) and the therapeutic outcome (eg, VM volume decrease, relief of symptoms) during a 1-year follow-up period. MR imaging-guided sclerotherapy was technically successful in all patients. A mean of 2.5 +/- 1.85 (range, 1-6) needle position corrections were needed for correct needle placement. The distribution of the sclerosing agent (mean amount, 10.5 mL; range, 0.8-33.0 mL) was clearly visible with real-time MR monitoring. One patient developed a compartment syndrome, which was managed with surgery. No other complications were observed. VM volumes significantly decreased by 53% (range, 24%-86%; P = .02) 12 weeks after therapy. Nine of the 10 patients (90%) noted an improvement of symptoms. In this limited preliminary series, 1.5-T MR imaging-guided percutaneous sclerotherapy for the treatment of VMs was feasible with a high degree of technical success, was relatively safe, and had a good therapeutic outcome after 1 year.

Abstract No. 238: The Use of n-Butyl-2-Cyanoacrylate (n-BCA) as an Adjunct to Sclerotherapy for Treatment of Venous Malformations - A Retrospective Review

Abstract No. 238: The Use of n-Butyl-2-Cyanoacrylate (n-BCA) as an Adjunct to Sclerotherapy for Treatment of Venous Malformations - A Retrospective Review