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SIR 2025

Venous Interventions

Traditional Poster

Session: Traditional Poster Presentations

125 - Impact of Augmented Fluoroscopy on Completeness of Sclerotherapy of Vascular Malformations

Monday, March 31, 2025
12:10 PM – 1:10 PM CT
Location: Music City Center, Expo Poster Area
Purpose: Sclerotherapy is a safe and effective treatment for peripheral low-flow vascular malformations (VMs). Diagnosis and surveillance of VMs typically uses MRI, while intra-procedure guidance frequently relies on a combination of ultrasound and fluoroscopy. The purpose of this study is to demonstrate a low-dose image-fusion approach to sclerotherapy of VMs, using fusion of pre-procedure imaging with live fluoroscopy to provide visual confirmation of the treatment endpoint.

Materials and Methods: Cases using augmented fluoroscopy (AF) for VM sclerotherapy were retrospectively reviewed. Standard-of-care imaging using ultrasound and fluoroscopy was used as primary guidance. AF (ASSIST, GE HealthCare) was used as adjunctive guidance by manually segmenting the target lesion and osseous landmarks from pre-procedure MRI and performing a 2D-3D registration using two oblique fluoroscopic views. Procedural parameters and clinical outcomes were reviewed.

Results: 10 sessions of percutaneous sclerotherapy were performed in 9 patients ranging in age from 7-74 years at a single institution from 2023-2024. All patients had an MRI of the lesion available prior to sclerotherapy. Technical success, characterized by ability to perform AF and anatomic overlap between the sclerosed (contrast-filled) volume and the segmented target, was achieved in all cases. However, the sclerosed volume did not perfectly overlap with the segmented target in any cases. Sotradecol was used as the sclerosant in 90% of sessions while bleomycin was used in 10% of sessions. Mean sclerosant volume was 5.0 mL. Mean procedure time was 75.2 minutes. Of 10 sessions, there was limited or no clinical follow-up in 4 cases, symptomatic improvement in 4 cases, and no change in 2 cases.

Conclusion: During VM sclerotherapy, low-dose image fusion can augment fluoroscopy guidance, overlaying the target lesion from pre-procedure MRI. Nonlinear positional differences, changes in lesion size, and distension of the lesion during sclerotherapy all contribute to differences between the pre-procedure segmentation of the target lesion and the true sclerosed volume. Nonetheless, AF can be helpful in ensuring sclerosant coverage of irregular, multifocal, or multilobulated VMs as well as in identifying and delineating lesions in which ultrasound findings are subtle.