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Image-Guided Percutaneous Injection Sclerotherapy of Venous Malformations

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Abstract

Venous malformations (VM) are the commonest types of vascular malformations, with an appropriate clinico-radiological diagnostic pathway being critical for establishing the correct diagnosis, mapping the extent of disease and involvement of important structures, guiding appropriate therapy, and predicting prognosis.

Ultrasound (US) with color Doppler examination is the first-line radiological investigation with magnetic resonance imaging being used for further evaluation, providing the exact lesion extent and involvement of muscles, bones, and neurovascular bundles. Direct puncture phlebography of the lesion confirms the diagnosis and classifies the lesion in four types. Type 1 is an isolated malformation without peripheral drainage, type 2 malformation drains into normal veins, type 3 malformation drains into dilated veins, and type 4 malformation represents dysplastic venous ectasia. Treatment is sought for cosmetic reasons, pain, and functional issues.

Sclerotherapy is the first-line treatment and image guidance, either US or phlebographic, is employed for the same. Various techniques are described including double or multiple puncture technique, subtraction-guided technique, filling defect technique, or a combination of these. Various sclerosants have been used including dry ethanol, polidocanol, ethanolamine oleate, sodium tetradecyl sulfate, sodium morrhuate, OKC 432, bleomycin, and doxycycline, either in liquid form or as microfoam prepared using Tessari’s technique. Typically, multiple sessions are needed and the lesions may recur; however, overall response rate, quality of life improvement, and patient satisfaction are significantly improved.

Local complications like pain, swelling, and ulcerations are common. Major complications of sclerotherapy are infrequent; however, pulmonary embolism, stroke, vision loss, compartment syndrome, tissue necrosis, hemolysis, anaphylaxis, nerve palsy, and pulmonary complications do occur and the patient and treating physicians should be aware of.

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References

  1. Dubois J, Soulez G, Oliva VL, Berthiaume MJ, Lapierre C, Therasse E. Soft-tissue venous malformations in adult patients: imaging and therapeutic issues. RadioGraphics. 2001;21(6):1519–31. https://doi.org/10.1148/radiographics.21.6.g01nv031519.

    Article  CAS  PubMed  Google Scholar 

  2. Mulligan PR, Prajapati HJS, Martin LG, Patel TH. Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches. Br J Radiol. 2014;87:20130392. https://doi.org/10.1259/bjr.20130392.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Eifert S, Villavicencio JL, Kao TC, Taute BM, Rich NM. Prevalence of deep venous anomalies in congenital vascular malformations of venous predominance. J Vasc Surg. 2000;31:462–71. https://doi.org/10.1067/mva.2000.101464.

    Article  CAS  PubMed  Google Scholar 

  4. Legiehn GM, Heran MKS. A step-by-step practical approach to imaging diagnosis and interventional radiologic therapy in vascular malformations. Semin Interv Radiol. 2010;27:209–31. https://doi.org/10.1055/s-0030-1253521.

    Article  Google Scholar 

  5. Legiehn GM, Heran MKS. Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin N Am. 2006;37:435–74. https://doi.org/10.1016/j.ocl.2006.04.005.

    Article  Google Scholar 

  6. Van der Vleuten CJ, Kater A, Wijnen MH, Schultze Kool LJ, Rovers MM. Effectiveness of sclerotherapy, surgery, and laser therapy in patients with venous malformations: a systematic review. Cardiovasc Intervent Radiol. 2014;37(4):977–89. https://doi.org/10.1007/s00270-013-0764-2.

    Article  PubMed  Google Scholar 

  7. Burrows PE. Endovascular treatment of slow-flow vascular malformations. Tech Vasc Interv Radiol. 2013;16(1):12–21. https://doi.org/10.1053/j.tvir.2013.01.003.

    Article  PubMed  Google Scholar 

  8. Park H, Kim JS, Park H, Kim JY, Huh S, Lee JM, et al. Venous malformations of the head and neck: a retrospective review of 82 cases. Arch Plast Surg. 2019;46(1):23–33. https://doi.org/10.5999/aps.2018.00458.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee BB. New approaches to the treatment of congenital vascular malformations (CVMs) - a single centre experience. Eur J Vasc Endovasc Surg. 2005;30:184–97.

    CAS  PubMed  Google Scholar 

  10. Gutierrez R. How to prevent complications and side effects from sclerotherapy of the lower limb veins. Phlebolymphology. 2018;25(2):137–53.

    Google Scholar 

  11. Worthington-Kirsch RL. Injection sclerotherapy. Semin Interv Radiol. 2005;22(3):209–17. https://doi.org/10.1055/s-2005-921954.

    Article  Google Scholar 

  12. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982;69:412–22. https://doi.org/10.1097/00006534-198203000-00002.

    Article  CAS  PubMed  Google Scholar 

  13. Jackson IT, Carreno R, Potparic Z, Hussain K. Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment. Plast Reconstr Surg. 1993;91(7):1216–30. https://doi.org/10.1097/00006534-199306000-00006.

    Article  CAS  PubMed  Google Scholar 

  14. Belov S. Anatomopathological classification of congenital vascular defects. Semin Vasc Surg. 1993;6:219–24.

    CAS  PubMed  Google Scholar 

  15. https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf

  16. Puig S, Aref H, Chigot V, Bonin B, Brunelle F. Classification of venous malformations in children and implications for sclerotherapy. Pediatr Radiol. 2003;33:99–103. https://doi.org/10.1007/s00247-002-0838-9.

    Article  PubMed  Google Scholar 

  17. Goyal M, Causer PA, Armstrong D. Venous vascular malformations in pediatric patients: comparison of results of alcohol sclerotherapy with proposed MR imaging classification. Radiology. 2002;223:639–44.

    PubMed  Google Scholar 

  18. Kumar S, Bhavana K, Kumar S, Kumar P. Ultrasound-guided polidocanol foam sclerotherapy for treating venous malformations. J Clin Ultrasound. 2018;46:23–31. https://doi.org/10.1002/jcu.22546.

    Article  PubMed  Google Scholar 

  19. Sadick M, Müller-Wille R, Wildgruber M, Wohlgemuth WA. Vascular anomalies (part I): classification and diagnostics of vascular anomalies. Rofo. 2018;190(9):825–35. https://doi.org/10.1055/a-0620-8925.

    Article  PubMed  Google Scholar 

  20. Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, et al. Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther. 2016;6(6):557–69. https://doi.org/10.21037/cdt.2016.11.10.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kumar S, Bhavana K, Kumar B, Sinha A, Kumar P. Image guided sclerotherapy of masseteric venous malformations. Ann Otol Rhinol Laryngol. 2020;129(6):548–55. https://doi.org/10.1177/0003489419898726.

    Article  PubMed  Google Scholar 

  22. Dompmartin A, Vikkula M, Boon LM. Venous malformation: update on etiopathogenesis, diagnosis & management. Phlebology. 2010;25(5):224–35. https://doi.org/10.1258/phleb.2009.0090041.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Vikkula M, Boon LM, Carraway KL 3rd, Calvert JT, Diamonti AJ, Goumnerov B, et al. Vascular dysmorphogenesis caused by an activating mutation in the receptor tyrosine kinase TIE2. Cell. 1996;87(7):1181–90. https://doi.org/10.1016/s0092-8674(00)81814-0.

    Article  CAS  PubMed  Google Scholar 

  24. Hermans C, Dessomme B, Lambert C, Deneys V. Venous malformations and coagulopathy. Ann Chir Plast Esthet. 2006;51(4–5):388–93.

    CAS  PubMed  Google Scholar 

  25. Mazoyer E, Enjolras O, Laurian C, Houdart E, Drouet L. Coagulation abnormalities associated with extensive venous malformations of the limbs: differentiation from Kasabach-Merritt syndrome. Clin Lab Haematol. 2002;24(4):243–51. https://doi.org/10.1046/j.1365-2257.2002.00447.x.

    Article  PubMed  Google Scholar 

  26. Boon LM, Mulliken JB, Vikkula M, Watkins H, Seidman J, Olsen BR, et al. Assignment of a locus for dominantly inherited venous malformations to chromosome 9p. Hum Mol Genet. 1994;3(9):1583–7.

    CAS  PubMed  Google Scholar 

  27. Limaye N, Wouters V, Uebelhoer M, Tuominen M, Wirkkala R, Mulliken JB, et al. Somatic mutations in angiopoietin receptor gene TEK cause solitary and multiple sporadic venous malformations. Nat Genet. 2009;41(1):118–24.

    CAS  PubMed  Google Scholar 

  28. Brouillard P, Boon LM, Mulliken JB, Enjolras O, Ghassibé M, Warman ML, et al. Mutations in a novel factor, glomulin, are responsible for glomuvenous malformations (“glomangiomas”). Am J Hum Genet. 2002 Apr;70(4):866–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Legiehn GM, Heran MK. Venous malformations: classification, development, diagnosis, and interventional radiologic management. Radiol Clin N Am. 2008;46(3):545–97.

    PubMed  Google Scholar 

  30. Boyd JB, Mulliken JB, Kaban LB, Upton J 3rd, Murray JE. Skeletal changes associated with vascular malformations. Plast Reconstr Surg. 1984;74:789–97. https://doi.org/10.1097/00006534-198412000-00010.

    Article  CAS  PubMed  Google Scholar 

  31. Paltiel HJ, Burrows PE, Kozakewich HP, Zurakowski D, Mulliken JB. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology. 2000;214:747–54. https://doi.org/10.1148/radiology.214.3.r00mr21747.

    Article  CAS  PubMed  Google Scholar 

  32. Trop I, Dubois J, Guibaud L, Grignon A, Patriquin H, McCuaig C, et al. Soft-tissue venous malformations in pediatric and young adult patients: diagnosis with Doppler US. Radiology. 1999;212:841–5.

    CAS  PubMed  Google Scholar 

  33. McCafferty IJ, Jones RG. Imaging and management of vascular malformations. Clin Radiol. 2011;66:1208–18. https://doi.org/10.1016/j.crad.2011.06.014.

    Article  CAS  PubMed  Google Scholar 

  34. Teh J. Ultrasound of soft tissue masses of the hand. J Ultrason. 2012;12(51):381–401. https://doi.org/10.15557/JoU.2012.0028.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Flors L, Leiva-Salinas C, Maged IM, Norton PT, Matsumoto AH, Angle JF, et al. MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. RadioGraphics. 2011;5:1321–40.

    Google Scholar 

  36. Bashir U, Shah S, Jeph S, O’Keeffe M, Khosa F. Magnetic resonance (MR) imaging of vascular malformations. Pol J Radiol. 2017;82:731–41. https://doi.org/10.12659/PJR.903491.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hagspiel K, Stevens P, Leung D, et al. Vascular malformations of the body: treatment follow-up using MRI and 3D gadolinium-enhanced MRA. In: CIRSE 2002. Abstracts of the annual meeting and postgraduate course of the Cardiovascular and Interventional Radiological Society of Europe and the 4th Joint Meeting with the European Society of Cardiac Radiology (ESCR). Lucern, Switzerland, October 5-9, 2002. Cardiovasc Intervent Radiol. 2002;25(suppl 2):S77–S265.

    Google Scholar 

  38. Olivieri B, White CL, Restrepo R, McKeon B, Karakas SP, Lee EY. Low-flow vascular malformation pitfalls: from clinical examination to practical imaging evaluation—part 2, venous malformation mimickers. AJR Am J Roentgenol. 2016;206(5):952–62. https://doi.org/10.2214/AJR.15.15794.

    Article  PubMed  Google Scholar 

  39. Goldman MP, Guex JJ, Bolton J. Mechanism of action of sclerotherapy. In: Goldman MP, Weiss RA, editors. Sclerotherapy 6thed: Treatment of varicose and telangiectatic leg veins: Elsevier China; 2017. p. 173–99.

  40. Feied C. Sclerosing solutions. In: Bergan JJ, editor. The vein book: Elsevier academic press; 2007. p. 125–31. https://doi.org/10.1016/B978-012369515-4/50016-8.

  41. Horbach SER, Lokhorst MMM, Saeed P, de Goüyon Matignon de Pontouraude CM, Rothová A, van der Horst CM. Sclerotherapy for low-flow vascular malformations of the head and neck: a systematic review of sclerosing agents. J Plast Reconstr Aesthet Surg. 2016;69(3):295–304. https://doi.org/10.1016/j.bjps.2015.10.045.

    Article  PubMed  Google Scholar 

  42. Albanese G, Kondo KL. Pharmacology of sclerotherapy. Semin Interv Radiol. 2010;27:391–9. https://doi.org/10.1055/s-0030-1267848.

    Article  Google Scholar 

  43. Vaidya S, Tozer KR, Chen J. An overview of embolic agents. Semin Interv Radiol. 2008;25(3):204–15. https://doi.org/10.1055/s-0028-1085930.

    Article  Google Scholar 

  44. Lee BB, Kim DI, Huh S, Kim HH, Choo IW, Byun HS, et al. New experiences with absolute ethanol sclerotherapy in the management of a complex form of congenital venous malformation. J Vasc Surg. 2001;33:764–72.

    CAS  PubMed  Google Scholar 

  45. Dubois J, Garel L, Gordon Culham JA. Pediatric interventional angiography. In: Baum S, Pentecost MJ, editors. Abrams’ angiography interventional radiology. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 1047–68.

    Google Scholar 

  46. Ellman BA, Parkhill BJ, Marcus PB, Curry TS, Peters PC. Renal ablation with absolute ethanol. Mechanism of action. Investig Radiol. 1984;19(5):416–23.

    CAS  Google Scholar 

  47. Sannier K, Dompmartin A, Théron J, Labbé D, Barrellier MT, Leroyer R, et al. A new sclerosing agent in the treatment of venous malformations. Study on 23 cases. Interv Neuroradiol. 2004;10(2):113–27. https://doi.org/10.1177/159101990401000203.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Dompmartin A, Blaizot X, Théron J, Hammer F, Chene Y, Labbé D, et al. Radio-opaque ethylcellulose-ethanol is a safe and efficient sclerosing agent for venous malformations. Eur Radiol. 2011;21(12):2647–56. https://doi.org/10.1007/s00330-011-2213-4.

    Article  PubMed  Google Scholar 

  49. Teusch VI, Wohlgemuth WA, Hammer S, Piehler AP, Müller-Wille R, Goessmann H, et al. Ethanol-gel sclerotherapy of venous malformations: effectiveness and safety. Am J Roentgenol. 2017;209(6):1390–5. https://doi.org/10.2214/AJR.16.17603.

    Article  Google Scholar 

  50. Mason KP, Michna E, Zurakowski D, Koka BV, Burrows PE. Serum ethanol level in children and adults after ethanol embolization or sclerotherapy for vascular anomalies. Radiology. 2000;217:127–32. https://doi.org/10.1148/radiology.217.1.r00se30127.

    Article  CAS  PubMed  Google Scholar 

  51. Yakes WS, Parker SH. Diagnosis and management of vascular anomalies. In: Castaneda-Zuniga WR, Tadavarthy SM, editors. Interventional radiology. Baltimore: Williams and Wilkins; 1992. p. 152–89.

    Google Scholar 

  52. Chapot R, Laurent A, Enjolras O, Payen D, Houdart E. Fatal cardiovascular collapse during ethanol sclerotherapy of a venous malformation. Interv Neuroradiol. 2002;8(3):321–4. https://doi.org/10.1177/159101990200800314.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Jo JY, Chin JH, Park PH, Ku SW. Cardiovascular collapse due to right heart failure following ethanol sclerotherapy: a case report. Korean J Anesthesiol. 2014;66(5):388–91. https://doi.org/10.4097/kjae.2014.66.5.388.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Mitchell SE, Shah AM, Schwengel D. Pulmonary artery pressure changes during ethanol embolization procedures to treat vascular malformations: can cardiovascular collapse be predicted? JVIR J Vasc Inter Radiol. 2006;17(2 pt 1):253–62.

    Google Scholar 

  55. Stefanutto TB, Halbach V. Bronchospasm precipitated by ethanol injection in arteriovenous malformation. AJNR Am J Neuroradiol. 2003;24(10):2050–1.

    PubMed  Google Scholar 

  56. Bisdorff A, Mazighi M, Saint-Maurice JP, Chapot R, Lukaszewicz AC, Houdart E. Ethanol threshold doses for systemic complications during sclerotherapy of superficial venous malformations: a retrospective study. Neuroradiology. 2011;53(11):891–4. https://doi.org/10.1007/s00234-010-0803-5.

    Article  PubMed  Google Scholar 

  57. Mol W, Furukawa H, Sasaki S, Tomaru U, Hayashi T, Saito A, et al. Evaluation of the sclerotherapeutic efficacy of ethanol, polidocanol, and OK-432 using an in vitro model. Dermatol Surg. 2007;33(12):1452–9.

    CAS  PubMed  Google Scholar 

  58. Higgins TT, Kittel PB. The use of sodium morrhuate in treatment of varicose veins by injection. Lancet. 1930;215(5550):68–9. https://doi.org/10.1016/S0140-6736(00)87234-7.

    Article  Google Scholar 

  59. Li L, Feng J, Zeng XQ, Li YH. Fluoroscopy-guided foam sclerotherapy with sodium morrhuate for peripheral venous malformations: preliminary experience. J Vasc Surg. 2009;49(4):961–7. https://doi.org/10.1016/j.jvs.2008.10.037.

    Article  PubMed  Google Scholar 

  60. Zhao JH, Zhang WF, Zhao YF. Sclerotherapy of oral and facial venous malformations with use of pingyangmycin and/or sodium morrhuate. Int J Oral Maxillofac Surg. 2004;33(5):463–6. https://doi.org/10.1016/j.ijom.2003.10.003.

    Article  PubMed  Google Scholar 

  61. Marrocco-Trischitta MM, Guerrini P, Abeni D, Stillo F. Reversible cardiac arrest after polidocanol sclerotherapy of peripheral venous malformation. Dermatol Surg. 2002;28:153–5.

    PubMed  Google Scholar 

  62. Jain R, Bandhu S, Sawhney S, Mittal R. Sonographically guided percutaneous sclerosis using 1% polidocanol in the treatment of vascular malformations. J Clin Ultrasound. 2002;30:416–23.

    PubMed  Google Scholar 

  63. Cabrera J, Cabrera J Jr, Garcia-Olmedo A, Redondo P. Treatment of venous malformations with sclerosant in microform foam. Arch Dermatol. 2003;139:1409–16. https://doi.org/10.1001/archderm.139.11.1409.

    Article  PubMed  Google Scholar 

  64. Blaise S, Charavin-Cocuzza M, Riom H, Brix M, Seinturier C, Diamand JM, et al. Treatment of low-flow vascular malformations by ultrasound-guided sclerotherapy with polidocanol foam: 24 cases and literature review. Eur J Vasc Endovasc Surg. 2011;41:412–7. https://doi.org/10.1016/j.ejvs.2010.10.009.

    Article  CAS  PubMed  Google Scholar 

  65. Suzuki N, Nakao A, Nonami T, Takagi H. Experimental study on the effects of sclerosants for esophageal varices on blood coagulation, fibrinolysis and systemic hemodynamics. Gastroenterol Jpn. 1992;27:309–16.

    CAS  PubMed  Google Scholar 

  66. Yamaki T, Nozaki M, Sakurai H, Takeuchi M, Soejima K, Kono T. Prospective randomized efficacy of ultrasound guided foam sclerotherapy compared with ultrasound-guided liquid sclerotherapy in the treatment of symptomatic venous malformations. J Vasc Surg. 2008;47:578–84.

    PubMed  Google Scholar 

  67. Eckmann DM. Polidocanol for endovenous microfoam sclerosant therapy. Expert Opin Investig Drugs. 2009;18(12):1919–27. https://doi.org/10.1517/13543780903376163.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Bonan PR, Miranda LP, Mendes DC, de Paula AM, Pego SP, Martelli-Júnior H. Effectiveness of low flow vascular lesions sclerosis with monoethanolamine: report of six cases. Med Oral Patol Oral Cir Bucal. 2007;12:524–7.

    Google Scholar 

  69. Choi YH, Han MH, O-Ki K, et al. Craniofacial cavernous venous malformations: percutaneous sclerotherapy with use of ethanolamine oleate. J Vasc Interv Radiol. 2002;13:475–82.

    PubMed  Google Scholar 

  70. Hashizume M, Kitano S, Yamaga H, Sugimachi K. Haptoglobin to protect against renal damage from ethanolamine oleate sclerosant. Lancet. 1988;2:340–1.

    CAS  PubMed  Google Scholar 

  71. Alexander MD, McTaggart RA, Choudhri OA, Marcellus ML, Do HM. Percutaneous sclerotherapy with ethanolamine oleate for venous malformations of the head and neck. J Neuro Interv Surg. 2014;6:695–8.

    Google Scholar 

  72. Costa JRS, Torriani MA, Hosni ES, D’Avila OP, de Figueiredo PJ. Sclerotherapy for vascular malformations in the oral and maxillofacial region: treatment and follow-up of 66 lesions. J Oral Maxillofac Surg. 2011;69:e88–92.

    PubMed  Google Scholar 

  73. Hoque S, Das BK. Treatment of venous malformations with ethanolamine oleate: a descriptive study of 83 cases. Pediatr Surg Int. 2011;27:527–31. https://doi.org/10.1007/s00383-010-2824-x.

    Article  PubMed  Google Scholar 

  74. Partovi S, Lu Z, Vidal L, Nakamoto DA, Ji B, Coffey M, et al. Real-time MRI-guided percutaneous sclerotherapy treatment of venous low-flow malformations in the head and neck. Phlebology. 2018;33(5):344–52. https://doi.org/10.1177/0268355517710110.

    Article  PubMed  Google Scholar 

  75. Reiner L. The activity of anionic surface-active compounds in producing vascular obliteration. Proc Soc Exp Biol Med. 1946;62:49–54. https://doi.org/10.3181/00379727-62-15369.

    Article  CAS  PubMed  Google Scholar 

  76. Stimpson P, Hewitt R, Barnacle A, Roebuck DJ, Hartley B. Sodium tetradecyl sulfate sclerotherapy for treating venous malformations of the oral and pharyngeal regions in children. Int J Pediatr Otorhinolaryngol. 2012;76:569–73.

    PubMed  Google Scholar 

  77. Alakailly X, Kummoona R, Quereshy FA, Baur DA, González AE. The use of sodium tetradecyl sulfate for the treatment of venous malformations of the head and neck. J Maxillofac Oral Surg. 2015;14(2):332–8. https://doi.org/10.1007/s12663-014-0623-y.

    Article  PubMed  Google Scholar 

  78. Tan KT, Kirby J, Rajan DK, Hayeema E, Beecroft JR, Simons ME. Percutaneous sodium tetradecyl sulfate sclerotherapy for peripheral venous vascular malformations: a single-center experience. JVIR J Vasc Inter Radiol. 2007;18(3):343–51. https://doi.org/10.1016/j.jvir.2006.12.735.

    Article  Google Scholar 

  79. Stuart S, Barnacle AM, Smith G, Pitt M, Roebuck DJ. Neuropathy after sodium tetradecyl sulfate sclerotherapy of venous malformations in children. Radiol. 2015;274(3):897–905. https://doi.org/10.1148/radiol.14132271.

    Article  Google Scholar 

  80. Orbach EJ. Contribution to the therapy of the varicose complex. J Int Coll Surg. 1950;13:765–71.

    CAS  PubMed  Google Scholar 

  81. Cabrera Garrido JR, Cabrera Garcia-Olmedo JR, Garcia-Olmedo Dominguez MA. Elargissement des limites de la sclérothérapie: noveaux produits sclérosants. Phlébologie. 1997;50:181–8.

    Google Scholar 

  82. Tessari L. Nouvelle technique d’obtention de la sclero-mousee. Phlebologie. 2000;53:129–33.

    Google Scholar 

  83. Rebuffini E, Zuccarino L, Grecchi E, Carinci F, Merulla VE. Picibanil (OK-432) in the treatment of head and neck lymphangiomas in children. Dent Res J. 2012;9(Suppl 2):S192–6. https://doi.org/10.4103/1735-3327.109752.

    Article  CAS  Google Scholar 

  84. Zhang W, Chen G, Ren JG, Zhao YF. Bleomycin induces endothelial mesenchymal transition through activation of mTOR pathway: a possible mechanism contributing to the sclerotherapy of venous malformations. Br J Pharmacol. 2013;170(6):1210–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  85. Sainsbury DC, Kessell G, Fall AJ, Hampton FJ, Guhan A, Muir T. Intralesional bleomycin injection treatment for vascular birthmarks: a 5-year experience at a single United Kingdom unit. Plast Reconstr Surg. 2011;127(5):2031–44.

    CAS  PubMed  Google Scholar 

  86. Karavelioğlu A, Temuçin CM, Tanyel FC, Ciftci AO, Senocak ME, Karnak I. Sclerotherapy with bleomycin does not adversely affect facial nerve function in children with cervicofacial cystic lymphatic malformation. J Pediatr Surg. 2010;45(8):1627–32.

    PubMed  Google Scholar 

  87. Shigematsu T, Sorscher M, Dier EC, Berenstein A. Bleomycin sclerotherapy for eyelid venous malformations as an alternative to surgery or laser therapy. JNIS J NeuroIntervent Surg. 2019;11(1):57–61.

    Google Scholar 

  88. Spence J, Krings T, terBrugge KG, da Costa LB, Agid R. Percutaneous sclerotherapy for facial venous malformations: subjective clinical and objective MR imaging follow-up results. AJNR Am J Neuroradiol. 2010;31(5):955–60. https://doi.org/10.3174/ajnr.A1940.

    Article  CAS  PubMed  Google Scholar 

  89. Horbach SE, Rigter IM, Smitt JH, Reekers JA, Spuls PI, van der Horst CM. Intralesional bleomycin injections for vascular malformations: a systematic review and meta-analysis. Plast Reconstr Surg. 2016;137(1):244–56.

    CAS  PubMed  Google Scholar 

  90. Zhang J, Li HB, Zhou SY, Chen KS, Niu CQ, Tan XY, et al. Comparison between absolute ethanol and bleomycin for the treatment of venous malformation in children. Exp Ther Med. 2013;6(2):305–9. https://doi.org/10.3892/etm.2013.1144.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Dubois J. Percutaneous sclerotherapy: recipe for perfect cooking. Pediatr Radiol. 2011;41(Suppl 1):S107–9. https://doi.org/10.1007/s00247-011-1982-x.

    Article  Google Scholar 

  92. Atwa K, Abuhasna S, Shihab Z, Hashaykeh N, Hasan R. Acute pulmonary toxicity following intralesional administration of bleomycin for a lymphovenous malformation. Pediatr Pulmonol. 2010;45(2):192–6.

    PubMed  Google Scholar 

  93. Jin Y, Lin X, Li W, et al. Sclerotherapy after embolization of draining vein: a safe treatment for venous malformations. J Vasc Surg. 2008;47:1292–9.

    PubMed  Google Scholar 

  94. Haq FU, Mitchell SE, Tekes A, Weiss CR. Bleomycin foam treatment of venous malformations: a promising agent for effective treatment with minimal swelling. JVIR J Vasc Interv Radiol. 2015;26(10):1484–93. https://doi.org/10.1016/j.jvir.2015.05.007.

    Article  Google Scholar 

  95. Jia R, Xu S, Huang X, Song X, Pan H, Zhang L, et al. Pingyangmycin as first-line treatment for low-flow orbital or periorbital venous malformations: evaluation of 33 consecutive patients. JAMA Ophthalmol. 2014;132:942–8.

    PubMed  Google Scholar 

  96. Hou R, Guo J, Hu K, Yang Y, Wang L, Kong L, et al. A clinical study of ultrasound-guided intralesional injection of bleomycin A5 on venous malformation in cervical-facial region in China. J Vasc Surg. 2010;51:940–5.

    PubMed  Google Scholar 

  97. Motz KM, Nickley KB, Bedwell JR, Yadav B, Guzzetta PC, Oh AK, et al. OK432 versus doxycycline for treatment of macrocystic lymphatic malformations. Ann Otol Rhinol Laryngol. 2014;123:81–8.

    PubMed  Google Scholar 

  98. Burrows PE, Mitri RK, Alomari A, Padua HM, Lord DJ, Sylvia MB, et al. Percutaneous sclerotherapy of lymphatic malformations with doxycycline. Lymphat Res Biol. 2008;6:209–16.

    CAS  PubMed  Google Scholar 

  99. Thomas DM, Wieck MM, Grant CN, Dossa A, Nowicki D, Stanley P, et al. Doxycycline sclerotherapy is superior in the treatment of pediatric lymphatic malformations. J Vasc Interv Radiol. 2016;27(12):1846–56. https://doi.org/10.1016/j.jvir.2016.08.012.

    Article  PubMed  Google Scholar 

  100. Puig S, Aref H, Brunelle F. Double-needle sclerotherapy of lymphangiomas and venous angiomas in children: a simple technique to prevent complications. AJR Am J Roentgenol. 2003;180(5):1399–401. https://doi.org/10.2214/ajr.180.5.1801399.

    Article  PubMed  Google Scholar 

  101. Puig S, Casati B, Staudenherz A, Paya K. Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol. 2005;53:35–45. https://doi.org/10.1016/j.ejrad.2004.07.023.

    Article  PubMed  Google Scholar 

  102. Dubois JM, Sebag GH, De Prost Y, et al. Soft-tissue venous malformations in children: percutaneous sclerotherapy with Ethibloc. Radiology. 1991;180:195–8.

    CAS  PubMed  Google Scholar 

  103. Ahmad S. Efficacy of percutaneous sclerotherapy in low flow malformations – a single center series. Neurointervention. 2019;14:53–60. https://doi.org/10.5469/neuroint.2019.0002.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Kitagawa A, Yamamoto T, Matsunaga N, Yamaji M, Ikeda S, Izumi Y, et al. Polidocanol sclerotherapy combined with transarterial embolization using n-butyl cyanoacrylate for extracranial arteriovenous malformations. Cardiovasc Intervent Radiol. 2018;41(6):856–66. https://doi.org/10.1007/s00270-017-1855-2.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Long L, Zeng XQ, Li YH. Digital subtraction angiography guided foam sclerotherapy of peripheral venous malformations. AJR Am J Roentgenol. 2010;194:W39–W444. https://doi.org/10.2214/AJR.09.3416.

    Article  Google Scholar 

  106. Zheng JW, Mai HM, Zhang L, Wang YA, Fan XD, Su LX, et al. Guidelines for the treatment of head and neck venous malformations. Int J Clin Exp Med. 2013;6(5):377–89.

    CAS  PubMed  PubMed Central  Google Scholar 

  107. Agid R, Burvin R, Gomori JM. Sclerotherapy for venous malformations using a “negative subtraction” technique. Neuroradiology. 2006;48(2):127–9. https://doi.org/10.1007/s00234-005-0019-2.

    Article  PubMed  Google Scholar 

  108. Gorman J, Zbarsky SJ, Courtemanche RJM, Arneja JS, Heran MKS, Courtemanche DJ. Image guided sclerotherapy for the treatment of venous malformations. CVIR Endovascular. 2018;1:2. https://doi.org/10.1186/s42155-018-0009-1.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Apostle KL, Heran MKS, Tredwell SJ. Acute compartment syndrome after sclerotherapy for a low-flow vascular malformation. Can J Surg. 2008;51(3):E50–1.

    PubMed  PubMed Central  Google Scholar 

  110. Donnelly LF, Bisset GS 3rd, Adams DM. Marked acute tissue swelling following percutaneous sclerosis of low-flow vascular malformations: a predictor of both prolonged recovery and therapeutic effect. Pediatr Radiol. 2000;30(6):415–9. https://doi.org/10.1007/s002470050775.

    Article  CAS  PubMed  Google Scholar 

  111. Legiehn GM. Sclerotherapy with adjunctive stasis of efflux (STASE) in venous malformations: techniques and strategies. Tech Vasc Interv Radiol. 2019;22(4):100630. https://doi.org/10.1016/j.tvir.2019.100630.

    Article  PubMed  Google Scholar 

  112. Pimpalwar S. Vascular malformations: approach by an interventional radiologist. Semin Plast Surg. 2014;28:91–103. https://doi.org/10.1055/s-0034-1376262.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Suh JS, Shin KH, Na JB, Won JY, Hahn SB. Venous malformations: sclerotherapy with a mixture of ethanol and lipiodol. Cardiovasc Intervent Radiol. 1997;20(4):268–73. https://doi.org/10.1007/s002709900150.

    Article  CAS  PubMed  Google Scholar 

  114. Uller W, El-sobky S, Alomari AI, Fishman SJ, Spencer SA, Taghinia AH, et al. Preoperative embolization of venous malformations using n-butyl cyanoacrylate. Vasc Endovasc Surg. 2018;52(4):269–74. https://doi.org/10.1177/1538574418762192.

    Article  Google Scholar 

  115. Hafner F, Froehlich H, Gary T, Brodman M. Intra-arterial injection, a rare but serious complication of sclerotherapy. Phlebology. 2013;28(2):64–73. https://doi.org/10.1258/phleb.2011.011155.

    Article  CAS  PubMed  Google Scholar 

  116. Thomas P, Martin J, Braithwaite B. Case report: inadvertent intra-arterial injection during sclerotherapy may not be the disaster you think. J Vasc Nurs. 2016;34(1):12–6. https://doi.org/10.1016/j.jvn.2015.09.003.

    Article  PubMed  Google Scholar 

  117. Rochon PJ. Importance of multidisciplinary approach to vascular malformation management. Semin Interv Radiol. 2017;34(3):301–2. https://doi.org/10.1055/s-0037-1604302.

    Article  Google Scholar 

  118. Yun WS, Kim YW, Lee KB, et al. Predictors of response to percutaneous ethanol sclerotherapy (PES) in patients with venous malformations: analysis of patient self-assessment and imaging. J Vasc Surg. 2009;50(3):581–589.e1. https://doi.org/10.1016/j.jvs.2009.03.058.

    Article  PubMed  Google Scholar 

  119. Aronniemi J, Castren E, Lappalainen K, Vuola P, Salminen P, Pitkaranta A, et al. Sclerotherapy complications of peripheral venous malformations. Phlebology. 2016;31(10):712–22. https://doi.org/10.1177/0268355515613740.

    Article  PubMed  Google Scholar 

  120. Nakamura M, Osuga K, Maeda N, Higashihara H, Hamada K, Hashimoto N, et al. Percutaneous sclerotherapy for venous malformations in the extremities: clinical outcomes and predictors of patient satisfaction. SpringerPlus. 2014;3:520. https://doi.org/10.1186/2193-1801-3-520.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Veräjänkorva E, Rautio R, Giordano S, Koskivuo I, Savolainen O. The efficiency of sclerotherapy in the treatment of vascular malformations: a retrospective study of 63 patients. Plast Surg Int. 2016;2016:2809152. https://doi.org/10.1155/2016/2809152.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Steiner F, FitzJohn T, Tan ST. Ethanol sclerotherapy for venous malformation. ANZ J Surg. 2016;86(10):790–5. https://doi.org/10.1111/ans.12833.

    Article  PubMed  Google Scholar 

  123. Orlando JL, Caldas JG, Campos HG, Nishinari K, Wolosker N. Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia. Clinics (Sao Paulo). 2010;65(9):837–40. https://doi.org/10.1590/s1807-59322010000900004.

    Article  Google Scholar 

  124. Khaitovich B, Kalderon E, Komisar O, Eifer M, Raskin D, Rimon U. Venous malformations sclerotherapy: outcomes, patient satisfaction and predictors of treatment success. Cardiovasc Intervent Radiol. 2019;42:1695–701. https://doi.org/10.1007/s00270-019-02338-y.

    Article  PubMed  Google Scholar 

  125. Karimi E, Jafari M, Aghazadeh K, Sohrabpour S, Tavakolnejad F. Treatment of head and neck venous malformations with sodium tetradecyl sulfate. OTO Open. 2018;2(3):2473974X18797067. https://doi.org/10.1177/2473974X18797067.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Inbaraj A, Keshava SN, Moses V, Koshy G, Ahmed M, Mammen S, et al. Sodium tetradecyl sulfate sclerotherapy for venous malformation of the tongue: a single-center experience. J Clin Interv Radiol ISVIR. 2018;02(02):076–82. https://doi.org/10.1055/s-0038-1669372.

    Article  Google Scholar 

  127. Rautio R, Laranne J, Kähärä V, Saarinen J, Keski-Nisula L. Long-term results and quality of life after endovascular treatment of venous malformations in the face and neck. Acta Radiol. 2004;45(7):738–45. https://doi.org/10.1080/02841850410001268.

    Article  CAS  PubMed  Google Scholar 

  128. Sadick NS. Hyperosmolar versus detergent sclerosing agents in sclerotherapy. Effect on distal vessel obliteration. J Dermatol Surg Oncol. 1994 May;20(5):313–6. https://doi.org/10.1111/j.1524-4725.1994.tb01630.x.

    Article  CAS  PubMed  Google Scholar 

  129. Xu D, Herzka DA, Gilson WD, McVeigh ER, Lewin JS, Weiss CR. MR-guided sclerotherapy of low-flow vascular malformations using T2 -weighted interrupted bSSFP (T2 W-iSSFP): comparison of pulse sequences for visualization and needle guidance. J Magn Reson Imaging. 2015;41(2):525–35. https://doi.org/10.1002/jmri.24552.

    Article  PubMed  Google Scholar 

  130. Sarig O, Kimel S, Orenstein A. Laser treatment of venous malformations. Ann Plast Surg. 2006;57(1):20–4. https://doi.org/10.1097/01.sap.0000210632.40697.9b.

    Article  CAS  PubMed  Google Scholar 

  131. Gao Y, Wang X, Suo W. Management of venous malformations with percutaneous radiofrequency thermal ablation. Br J Dermatol. 2012;167(3):637–42. https://doi.org/10.1111/j.1365-2133.2012.10963.x.

    Article  CAS  PubMed  Google Scholar 

  132. Ramaswamy RS, Tiwari T, Darcy MD, Kim SK, Akinwande O, Dasgupta N, et al. Cryoablation of low-flow vascular malformations. Diagn Interv Radiol. 2019;25(3):225–30. https://doi.org/10.5152/dir.2019.18278.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Subhash Kumar

  2. Department of ENT, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, 801507, Bihar, India

    Kranti Bhavana & Bhartendu Bharti

  3. Department of Pediatric Surgery, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, 801507, Bihar, India

    Amit Kumar Sinha

  4. Department of CTVS, All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, 801507, Bihar, India

    Sanjeev Kumar

  5. Department of Pediatrics (T&E), All India Institute of Medical Sciences Patna, Phulwarisharif, Patna, 801507, Bihar, India

    Arun Prasad

  6. Department of Radiodiagnosis, Nalanda Medical College and Hospital, Mahatma Gandhi Nagar, Patna, 800026, Bihar, India

    Pranav Kumar Santhalia

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Video 1

Color Doppler of a patient with thigh venous malformation, showing partial compressibility of the lesion on probe compression (MP4 1745 kb)

Video 2

4D TRICKS angiography of a case of multi-compartmental venous malformation involving the parotid, masseter, submandibular region, showing nodular filling in the arterial phase with progressive visualization of large veins traversing the lesion, as well as large venous pouch in the inferior part of the lesion connecting to the internal jugular vein. (AVI 16130 kb)

Video 3

Microfoam preparation with 3% polidocanol, two Luer lock syringes are attached to a threeway stop cock, the hub is rotated just sufficient to produce some resistance, then firm to and fro passage of air and drug across the rotating hub agitates the mixture producing foam. A similar effort can be made using one 10 ml and another 5 ml syringe or using mechanized instruments with the same principle. (MP4 2636 kb)

Video 4

Microfoam filling of a venous malformation (MP4 1407 kb)

Video 5

Needle positioning in a complex infiltrating venous malformation, the needle was inserted out of the plane and the tip can be difficult to visualize in such situations. Gentle needling helps in tip visualization and thus appropriate placement (MP4 10.7 kb)

Video 6

Foam passing into internal jugular vein appearing as tiny hyperechoic specks (MP4 163 kb)

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Kumar, S., Bhavana, K., Sinha, A.K. et al. Image-Guided Percutaneous Injection Sclerotherapy of Venous Malformations. SN Compr. Clin. Med. 2, 1462–1490 (2020). https://doi.org/10.1007/s42399-020-00412-y

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