Sclerotherapy- An effective way to treat Vascular malformation- ISSVA Grade 2 and 3.

Purpose: Vascular Malformations are caused by a disturbance in the late stages of angiogenesis (truncal stage) and result in the persistence of arteriovenous anastomosis present during embryonic life {1}.
Recently, increasing interest has emerged in minimally invasive treatment, and McCafferty and Lee consider non-surgical treatment such as sclerotherapy to be an important option for the treatment of vascular malformations {2,3}.

The aim of this study was to evaluate treatment response after sclerotherapy in patients with Vascular Malformations and assess the Clinical, Radiological response and Quality Index of life in patients with ISSVA (International Society for the Study of Vascular Anomalies) Type II and III Vascular Malformations.

Materials and Methods: A retrospective study of 100 patients with VM (ISSVA grade 2 and 3), which were accessible to percutaneous sclerotherapy. All patients had undergone baseline MRI and USG of the affected area and were followed up after one month with clinical response and imaging to assess the presence of a residual lesion. On follow up, the decision to treat by repeat/ another session of sclerotherapy was based on clinical and degree of residual lesion noted in follow up imaging and recurrence of symptoms. The clinical response was evaluated as per EORTC QLQ-C30 Score (European Organization for Research and Treatment of Cancer). The volume of the lesions in follow-up visits and compared to baseline on the imaging.

Results: In the present study, the majority of the patients (32%) were from the age group of 11-20 years with mean age of 21.57 ± 11.83 years. The mean pre-procedure lesion size of patients was 167.27 ± 168.86 cm3. The mean number of sessions of sclerotherapy was 5.
The mean pre and post procedure VAS score was 7.05 and 2.61, respectively with a significant difference in VAS score as per the Student t-test (p< 0.05).
The mean pre and post-procedure EORTC QLQ-C30 score was 7.01 and 3.43, respectively with a significant difference in EORTC QLQ-C30 score as per the Student t-test (p< 0.05).
The mean pre and post-procedure lesion size of patients was 167.27 cm3 and 56.18 cm3, respectively with a significant difference in lesion size as per Student t-test (p< 0.05).
The mean dose of sclerosant used was 27.14 ml. 

Conclusion: Sclerotherapy is a well-tolerated method in the treatment of VMs. Smaller lesions have a more favorable response. Sclerotherapy is a cost-effective procedure with low complications, significant clinical improvement and a high success rate offering an effective and cheap treatment option to most patients suffering from vascular malformations.