Abstract
Background
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.
Methods
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.
Results and conclusions
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.
Similar content being viewed by others
Abbreviations
- VMs:
-
Venous malformations
References
Mulliken JB, Glowacki J (1982) Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 69(3):412–422
Berenguer B, Burrows PE, Zurakowski D, Mulliken JB (1999) Sclerotherapy of craniofacial venous malformations: complications and results. Plast Reconstr Surg 104(1):1–11 discussion 2–5
Puig S, Casati B, Staudenherz A, Paya K (2005) Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol 53(1):35–45
Raymond-Martimbeau P (1993) Advanced sclerotherapy treatment of varicose veins with duplex ultrasonographic guidance. Semin Dermatol 12(2):123–128
Lee CH, Chen SG (2005) Direct percutaneous ethanol instillation for treatment of venous malformation in the face and neck. Br J Plast Surg 58(8):1073–1078
Rebeiz E, April MM, Bohigian RK, Shapshay SM (1991) Nd-YAG laser treatment of venous malformations of the head and neck: an update. Otolaryngol Head Neck Surg 105(5):655–661
Huang T, Kim KA, Lynch JB, Doyle JE, Lewis SR (1972) The use of cryotherapy in the management of intra-oral hemangiomas. South Med J 65(9):1123–1127
Donnelly LF, Adams DM, Bisset GS 3rd (2000) Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 174(3):597–608
Yamaki T, Nozaki M, Sasaki K (2000) Color duplex-guided sclerotherapy for the treatment of venous malformations. Dermatol Surg 26(4):323–328
Jain R, Bandhu S, Sawhney S, Mittal R (2002) Sonographically guided percutaneous sclerosis using 1% polidocanol in the treatment of vascular malformations. J Clin Ultrasound 30(7):416–423
Mahesh B, Thulkar S, Joseph G, Khazanchi RK, Srivastava A (2003) Colour duplex ultrasound-guided sclerotherapy: a new approach to the management of patients with peripheral vascular malformations. Clin Imaging 27(3):171–179
Lewin JS, Merkle EM, Duerk JL, Tarr RW (1999) Low-flow vascular malformations in the head and neck: safety and feasibility of MR imaging-guided percutaneous sclerotherapy—preliminary experience with 14 procedures in three patients. Radiology 211(2):566–570
Mimura H, Kanazawa S, Yasui K, Fujiwara H, Hyodo T, Mukai T et al (2003) Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy. Acta Med Okayama 57(5):227–234
Nishikawa M, Sakamoto K, Hidaka M, Yamashita A, Yamamoto G (2006) Venous malformation of the tongue in a child treated by sclerotherapy with ethanolamine oleate: a case report. J Pediatr Surg 41(3):599–600
Lee BB, Kim DI, Huh S, Kim HH, Choo IW, Byun HS et al (2001) New experiences with absolute ethanol sclerotherapy in the management of a complex form of congenital venous malformation. J Vasc Surg 33(4):764–772
Svendsen P, Wikholm G, Rodriguez-Catarino M (2002) Venous malformations in the head and neck should be treated. Lakartidningen 99(14):1574–1578
de Lorimier AA (1995) Sclerotherapy for venous malformations. J Pediatr Surg 30(2):188–193 discussion 94
Gelczer RK, Charboneau JW, Hussain S, Brown DL (1998) Complications of percutaneous ethanol ablation. J Ultrasound Med 17(8):531–533
Marrocco-Trischitta MM, Guerrini P, Abeni D, Stillo F (2002) Reversible cardiac arrest after polidocanol sclerotherapy of peripheral venous malformation. Dermatol Surg 28(2):153–155
Connor WE, Hoak JC, Warner ED (1963) Massive thrombosis produced by fatty acid infusion. J Clin Invest 42:860–866
Miyoshi H, Oshiba S, Matsumoto A, Hayashi K, Tei H (1989) The prophylactic effect of haptoglobin administration on renal disfunction in endoscopic injection sclerotherapy. Nippon Shokakibyo Gakkai Zasshi 86(2):280
Astner S, Anderson RR (2005) Treating vascular lesions. Dermatol Ther 18(3):267–281
Choi YH, Han MH, O-Ki K, Cha SH, Chang KH (2002) Craniofacial cavernous venous malformations: percutaneous sclerotherapy with use of ethanolamine oleate. J Vasc Interv Radiol 13(5):475–482
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Uehara, S., Osuga, K., Yoneda, A. et al. Intralesional sclerotherapy for subcutaneous venous malformations in children. Pediatr Surg Int 25, 709–713 (2009). https://doi.org/10.1007/s00383-009-2414-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-009-2414-y