Positive Impact of Cone Beam CT in Treatment of Vascular Malformations

Monday, March 31, 2025

3:54 PM – 4:03 PM CT

Location: Music City Center, 202 A

Presenting Author(s)

Avery R. McCutchen (she/her/hers)

Medical Student
Wake Forest University School of Medicine, United States

Author/Co-author(s)

AP

Achintya Patel, MD

Resident
Atrium Health Wake Forest Baptist, United States
Michael J. Miller, Jr., MD, FSIR

Associate Professor of Radiology/ Interventional Radiology
Atrium Heath Wake Forest Baptist Hospital, United States

Purpose: Determine the impact of cone beam CT (CBCT) safety and outcomes in patients with sclerotherapy of vascular malformations.

Materials and Methods: A retrospective review of 166 sclerotherapy procedures for treatment of vascular malformations from 2018 to 2024 at a single institution. Sclerotherapy procedures were performed in 92 patients, with 78 interventions across 46 patients utilizing CBCT, and 88 interventions across 56 patients only using fluoroscopy or ultrasound. The average age of patients was 26.1 years old, and 66.3% of the patients were female. The primary outcome was the response to sclerotherapy as reduction of signs and symptoms in comparison of CBCT to fluoroscopy alone. Responses were categorized as no/minimal response (0-24%), partial response (25-90%), and near complete/complete response ( >90%). Secondary outcomes included radiation dose (mGy), fluoroscopy time (minutes), number of interventions, and complications.

Results: Responses in procedures using CBCT were complete/near complete in 28.2%, partial in 64.1%, and minimal/none in 7.7%. Responses in patients without the use of CBCT were complete/near complete in 21.6%, partial in 52.3%, and minimal/none in 26.1%. A significant improvement in response was seen in patients using CBCT (p=0.0203). Radiation dose (p=0.8816) and fluoroscopy time (p=0.0547) were not significantly different between the two groups. The average number of interventions per malformation per patient was 1.67 in patients receiving CBCT, and 1.52 in patients without using CBCT. In patients with CBCT guided treatment, minor complications occurred in 23.1% of interventions, and included swelling and pain, cellulitis, ulceration, bleeding, shortness of breath, fever, nausea, and skin discoloration. Major complications occurred in 3 patients who received CBCT, and included prolonged hospitalization due to Klebsiella bacteremia, a subsegmental pulmonary embolism requiring hospitalization, and skin necrosis requiring surgical debridement. In procedures without CBCT, minor complications occurred in 26.1% of interventions and included swelling and pain, cellulitis, hematoma, stridor, ulceration, nausea, post-thrombotic syndrome, bleeding, reduced range of motion, and fever. No major complications occurred in patients without CBCT.

Conclusion: CBCT assisted sclerotherapy of vascular malformations improves outcomes with no significant difference in radiation exposure and a clinically insignificant difference in complications.