Sclerotherapy of Diffuse and Infiltrative Venous Malformations of the Hand and Distal Forearm

  • Carlos J. Guevara
  • Guillermo Gonzalez-Araiza
  • Seung K. Kim
  • Elizabeth Sheybani
  • Michael D. Darcy
Clinical Investigation



Venous malformations (VM) involving the hand and forearm often lead to chronic pain and dysfunction, and the threshold for treatment is high due to the risk of nerve and skin damage, functional deterioration and compartment syndrome. The purpose of this study is to demonstrate that sclerotherapy of diffuse and infiltrative VM of the hand is a safe and effective therapy.

Materials and Methods

A retrospective review of all patients with diffuse and infiltrative VM of the hand and forearm treated with sclerotherapy from 2001 to 2014 was conducted. All VM were diagnosed during the clinical visit by a combination of physical examination and imaging. Sclerotherapy was performed under imaging guidance using ethanol and/or sodium tetradecyl sulfate foam. Clinical notes were reviewed for signs of treatment response and complications, including skin blistering and nerve injury.


Seventeen patients underwent a total of 40 sclerotherapy procedures. Patients were treated for pain (76 %), swelling (29 %) or paresthesias (6 %). Treatments utilized ethanol (70 %), sodium tetradecyl sulfate foam (22.5 %) or a combination of these (7.5 %). Twenty-four percent of patients had complete resolution of symptoms, 24 % had partial relief of symptoms without need for further intervention, and 35 % had some improvement after initial treatment but required additional treatments. Two skin complications were noted, both of which resolved. No motor or sensory loss was reported.


Sclerotherapy is a safe and effective therapy for VM of the hand with over 83 % of patients experiencing relief.


Venous malformation Sclerotherapy 


  1. 1.
    Burrows PE. Endovascular treatment of slow-flow vascular malformations. Tech Vasc Interv Radiol. 2013;16(1):12–21. doi:10.1053/j.tvir.2013.01.003.CrossRefPubMedGoogle Scholar
  2. 2.
    Mendonca DA, McCafferty I, Nishikawa H, et al. Venous malformations of the limbs: the Birmingham experience, comparisons and classification in children. J Plast Reconstr Aesthet Surg. 2010;63:383–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Delgado J, Bedoya MA, Gaballah M, Low DW, Cahill AM. Percutaneous sclerotherapy of foot venous malformations: evaluation of clinical response. Clin Radiol. 2014;69(9):931–8. doi:10.1016/j.crad.2014.04.014 retain Epub 2014 May 24.CrossRefPubMedGoogle Scholar
  4. 4.
    Wassef M, Blei F, Adams D, Alomari A, Baselga E, Berenstein A, Burrows P, Frieden IJ, Garzon MC, Lopez-Gutierrez JC, Lord DJ, Mitchel S, Powell J, Prendiville J, Vikkula M; ISSVA Board and Scientific Committee. Vascular anomalies classification: recommendations from the international society for the study of vascular anomalies. Pediatrics. 2015 Jul;136(1):e203–14. doi:10.1542/peds.2014-3673. Epub 2015 Jun 8. Review. PubMed PMID: 26055853.
  5. 5.
    Guevara CJ, Alomari AI. Interdisciplinary approach to treatment of vascular anomalies. Tech Vasc Interv Radiol. 2013;16(1):55–8. doi:10.1053/j.tvir.2013.01.008.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee BB. Venous malformation and haemangioma: differential diagnosis, diagnosis, natural history and consequences. Phlebology. 2013;28(Suppl. 1):176–87.CrossRefPubMedGoogle Scholar
  7. 7.
    Qiu Y, Chen H, Lin X, Hu X, Jin Y, Ma G. Outcomes and complications of sclerotherapy for venous malformations. Vasc Endovasc Surg. 2013;47(6):454–61. doi:10.1177/1538574413492390.CrossRefGoogle Scholar
  8. 8.
    Fujiki M, Kurita M, Ozaki M, Kawakami H, Kaji N, Takushima A, Harii K. Detrimental influences of intraluminally-administered sclerotic agents on surrounding tissues and peripheral nerves: an experimental study. J Plast Surg Hand Surg. 2012;46(3–4):145–51. doi:10.3109/2000656X.2012.675881.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Berenguer B, Burrows PE, Zurakowski D, et al. Sclerotherapy of craniofacial venous malformations: complications and results. Plast Reconstr Surg. 1999;104(1):1–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Carlos J. Guevara
    • 1
  • Guillermo Gonzalez-Araiza
    • 1
  • Seung K. Kim
    • 1
  • Elizabeth Sheybani
    • 1
  • Michael D. Darcy
    • 1
  1. 1.Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisUSA

Personalised recommendations