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

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

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.

Materials and Methods

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.

Results

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.

Conclusion

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.

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Conflict of interest

All authors, C.J.M. van der Vleuten, A. Kater, M.H.W.A. Wijnen, L.J. SchultzeKool, M.M. Rovers, declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Dermatology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Carine J. M. van der Vleuten

  2. Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Anne Kater

  3. Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Marc H. W. A. Wijnen

  4. Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Leo J. Schultze Kool

  5. Department of Operating Rooms and Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Maroeska M. Rovers

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  1. Carine J. M. van der Vleuten
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  2. Anne Kater
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Corresponding author

Correspondence to Carine J. M. van der Vleuten.

Appendix: Search Strategy

Appendix: Search Strategy

Ethanol

  • Search strategy pubmed: (ethanol[Title/Abstract] AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: ((absolute[Title/Abstract] AND ethanol[Title/Abstract]) AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: (alcohol[Title/Abstract] AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: ((absolute[Title/Abstract] AND alcohol[Title/Abstract]) AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: ((“ethanol”[MeSH Terms] OR “ethanol”[All Fields]) AND (“sclerotherapy”[MeSH Terms] OR “sclerotherapy”[All Fields])) AND ((“veins”[MeSH Terms] OR “veins”[All Fields] OR “venous”[All Fields]) AND (“congenital abnormalities”[MeSH Terms] OR (“congenital”[All Fields] AND “abnormalities”[All Fields]) OR “congenital abnormalities”[All Fields] OR “malformation”[All Fields]))

  • Search strategy embase: (ethanol and sclerotherapy and venous malformation).ab.

  • Search strategy embase: (alcohol and sclerotherapy and venous malformation).ab.

  • Search strategy embase: (absolute ethanol and sclerotherapy and venous malformation).ab.

  • Search strategy embase: (absolute alcohol and sclerotherapy and venous malformation).ab.

Bleomycin

  • Search strategy pubmed: (bleomycin[Title/Abstract] AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: (pingyangmycin[Title/Abstract] AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: ((“bleomycin”[MeSH Terms] OR “bleomycin”[All Fields]) AND (“sclerotherapy”[MeSH Terms] OR “sclerotherapy”[All Fields])) AND ((“veins”[MeSH Terms] OR “veins”[All Fields] OR “venous”[All Fields]) AND (“congenital abnormalities”[MeSH Terms] OR (“congenital”[All Fields] AND “abnormalities”[All Fields]) OR “congenital abnormalities”[All Fields] OR “malformation”[All Fields]))

  • Search strategy pubmed: ((“bleomycetin”[Supplementary Concept] OR “bleomycetin”[All Fields] OR “pingyangmycin”[All Fields]) AND (“sclerotherapy”[MeSH Terms] OR “sclerotherapy”[All Fields])) AND ((“veins”[MeSH Terms] OR “veins”[All Fields] OR “venous”[All Fields]) AND (“congenital abnormalities”[MeSH Terms] OR (“congenital”[All Fields] AND “abnormalities”[All Fields]) OR “congenital abnormalities”[All Fields] OR “malformation”[All Fields]))

  • Search strategy embase: (bleomycine and sclerotherapy and venous malformation).ab.

  • Search strategy embase: (pingyangmycine and sclerotherapy and venous malformation).ab.

Polidocanol

  • Search strategy pubmed: ((venous[Title/Abstract] AND malformation[Title/Abstract]) AND sclerotherapy[Title/Abstract]) AND polidocanol[Title/Abstract]

  • Search strategy pubmed: (aetoxisclerol[Title/Abstract] AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: (((aetoxisklerol[Title/Abstract])) AND (sclerotherapy[Title/Abstract])) AND (venous malformation[Title/Abstract])

  • Search strategy pubmed: (etoxisclerol[Title/Abstract] AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed:((“polidocanol”[Supplementary Concept] OR “polidocanol”[All Fields] OR “aetoxisclerol”[All Fields]) AND (“sclerotherapy”[MeSH Terms] OR “sclerotherapy”[All Fields])) AND ((“veins”[MeSH Terms] OR “veins”[All Fields] OR “venous”[All Fields]) AND (“congenital abnormalities”[MeSH Terms] OR (“congenital”[All Fields] AND “abnormalities”[All Fields]) OR “congenital abnormalities”[All Fields] OR “malformation”[All Fields]))

  • Search strategy embase: (polidocanol and sclerotherapy and venous malformation).ab.

  • Search strategy embase: (aetoxisclerol and sclerotherapy and venous malformation).ab.

  • Search strategy embase: (aetoxisklerol and sclerotherapy and venous malformation).ab.

  • Search strategy embase: (etoxisclerol and sclerotherapy and venous malformation).ab.

STS

  • Search strategy pubmed: ((sodium[Title/Abstract] AND tetradecyl[Title/Abstract] AND sulfate[Title/Abstract]) AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: ((“sodium tetradecyl sulphate”[All Fields] OR “sodium tetradecyl sulfate”[MeSH Terms] OR (“sodium”[All Fields] AND “tetradecyl”[All Fields] AND “sulfate”[All Fields]) OR “sodium tetradecyl sulfate”[All Fields]) AND (“sclerotherapy”[MeSH Terms] OR “sclerotherapy”[All Fields])) AND ((“veins”[MeSH Terms] OR “veins”[All Fields] OR “venous”[All Fields]) AND (“congenital abnormalities”[MeSH Terms] OR (“congenital”[All Fields] AND “abnormalities”[All Fields]) OR “congenital abnormalities”[All Fields] OR “malformation”[All Fields]))

  • Search strategy pubmed: (sotradecol[Title/Abstract] AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: ((sodium[Title/Abstract] AND lauryl[Title/Abstract] AND sulfate[Title/Abstract]) AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy: (sodium tetradecyl sulfate and sclerotherapy and venous malformation).ab

  • Search strategy embase: (sotradecol and sclerotherapy and venous malformation).ab.

  • Search strategy embase: (sodium lauryl sulfate and sclerotherapy and venous malformation).ab.

Ethibloc

  • Search strategy pubmed: (ethibloc[Title/Abstract] AND sclerotherapy[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: ((“alcoholic prolamine solution”[Supplementary Concept] OR “alcoholic prolamine solution”[All Fields] OR “ethibloc”[All Fields]) AND (“sclerotherapy”[MeSH Terms] OR “sclerotherapy”[All Fields])) AND ((“veins”[MeSH Terms] OR “veins”[All Fields] OR “venous”[All Fields]) AND (“congenital abnormalities”[MeSH Terms] OR (“congenital”[All Fields] AND “abnormalities”[All Fields]) OR “congenital abnormalities”[All Fields] OR “malformation”[All Fields]))

  • Search strategy: (ethibloc and sclerotherapy and venous malformation).ab.

Surgery

  • Search strategy pubmed: (surgical[Title/Abstract] AND treatment[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: ((surgical[Title/Abstract] AND treatment[Title/Abstract]) AND (vascular[Title/Abstract] AND surgery[Title/Abstract])) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy embase: (surgery and venous malformation).ab.

Laser

  • Search strategy pubmed: (((laser[Title/Abstract] AND therapy[Title/Abstract]) AND laser[Title/Abstract]) AND treatment[Title/Abstract]) AND (venous[Title/Abstract] AND malformation[Title/Abstract])

  • Search strategy pubmed: (((“laser therapy, low-level”[MeSH Terms] OR (“laser”[All Fields] AND “therapy”[All Fields] AND “low-level”[All Fields]) OR “low-level laser therapy”[All Fields] OR (“laser”[All Fields] AND “therapy”[All Fields]) OR “laser therapy”[All Fields] OR “laser therapy”[MeSH Terms] OR (“laser”[All Fields] AND “therapy”[All Fields])) AND (“lasers”[MeSH Terms] OR “lasers”[All Fields] OR “laser”[All Fields])) AND (“therapy”[Subheading] OR “therapy”[All Fields] OR “treatment”[All Fields] OR “therapeutics”[MeSH Terms] OR “therapeutics”[All Fields])) AND ((“veins”[MeSH Terms] OR “veins”[All Fields] OR “venous”[All Fields]) AND (“congenital abnormalities”[MeSH Terms] OR (“congenital”[All Fields] AND “abnormalities”[All Fields]) OR “congenital abnormalities”[All Fields] OR “malformation”[All Fields]))

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van der Vleuten, C.J.M., Kater, A., Wijnen, M.H.W.A. et al. Effectiveness of Sclerotherapy, Surgery, and Laser Therapy in Patients With Venous Malformations: A Systematic Review. Cardiovasc Intervent Radiol 37, 977–989 (2014). https://doi.org/10.1007/s00270-013-0764-2

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  • DOI: https://doi.org/10.1007/s00270-013-0764-2

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