SIR 2024
Venous Interventions
Marisabel Linares-Bolsegui, MD, MPH (she/her/hers)
Postdoctoral Research Fellow
The Johns Hopkins Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Amanda R. Laguna, BS
Medical Student
Warren Alpert Medical School of Brown University
Disclosure information not submitted.
Clifford R. Weiss, MD, FSIR
Professor of Radiology and Biomedical Engineering
The Johns Hopkins Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
All patients who received sclerotherapy for lower extremity VMs at a major tertiary medical center between December 2005 and June 2021 were reviewed with previous IRB approval. Clinical and imaging findings were assessed to evaluate clinical response, lesion size changes, and complication rates. Sub-stratification analysis was performed with respect to type of sclerosing agent. SIR classification criteria were used to categorize adverse events.
Results:
A total of 251 patients (63.3% F) underwent 581 sclerotherapies between December 2005 and June 2021, with a median of 2 procedures per patient. The most common symptoms were pain (57.8%), lesion enlargement (12.4%), functional deficit (8.4%), cosmetic deformities (5.9%), discoloration (4.4%) and bleeding (2%). The rate of technical success was 72.12%. The most common embolization agent was Ethanol (54.3%), followed by Sotradecol Foam (22.3%), and Bleomycin (14.9%). Clinical scores were available only for foot and ankle lesions (54/251; 22%), sclerotherapy significantly improved clinical symptoms (p < 0.0001) showing: resolution (9/54; 16.4%), improvement (32/54; 58.2%) non change or worsening (13/54; 23.5%) of the lesion. A total of 228 MRIs were performed indicating: decrease (48.2%), no change (37.7%), increase (12.7%) in size, or resolution (1.3%). There were (11.1%) minor reported adverse events including skin burn (14.3%) and transient motor nerve injury (7.1%) from which (75%) completely resolved.
Conclusion: Percutaneous sclerotherapy significantly decreases lesion size and improves clinical symptoms of lower extremities. Percutaneous sclerotherapy is a safe and effective treatment modality for the management of venous malformations involving the lower extremities, providing long-lasting symptom relief, improve quality of life, and may be a cost-effective and less invasive alternative to surgery.