87 - Early single centre experience of cryoablation for pain management of low flow vascular malformations and benign vascular soft tissue tumors

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

BW

Blair Warren, MD

IR Fellow
University of Toronto, Canada

Author/Co-author(s)

JK

Julian Kwon, None

Research Student
University Health Network, Canada
Alanna Joyce Supersad, MD (she/her/hers)

Interventional Radiology Fellow
University of Toronto - University Health Network (UHN), Canada
AQ

Aziz Qazi, MD

Vascular and Interventional Radiologist
University of Toronto, University Health Network, Canada

Purpose: Retrospective study of the safety and efficacy of cryoablation (Cryo) for pain management in low flow vascular malformations and benign soft tissue vascular tumors.

Materials and Methods: Retrospective review of patients who received Cryo for vascular malformations with at least 1 clinical follow-up between January 2023 and June 2024. Preprocedural and follow-up imaging maximal dimension of the mass was documented including the enhancing component where available. Binary pain response was recorded pre-procedure and at follow-up. Statistical significance determined using the sign test for binary data and Wilcoxon test for ordinal data.

Results:

Twelve patients underwent Cryo and median baseline tumor size was 3.3 cm (range 1.5 - 12.4 cm). Pre-procedural biopsy was performed in 4 cases: 2 intramusclar hemangiomas, 1 suspected low-flow vascular malformation, and 1 angioleiomyoma. Eight (8/12) of the patients had received prior sclerotherapy for their lesions. 100% of patients (12/12) reported lesion-associated pain pre-procedure. Single session Cryo was performed for all patients with lesion dependent cryoablation protocols used. Total freeze time ranged from 8 to 20 minutes. Median follow-up time was 2.5 months (range 1.5 - 8 months). 100% of patients reported improvement in pain post Cryo (12/12, p < .001) at final documented follow-up. One immediate complication was observed, a local hematoma that was managed conservatively. No delayed complications were seen. Follow-up imaging was available for 5/12 patients with no significant reduction in size (median size: 3.3 cm, range 1.3 – 12.3 cm, p = 0.10) to pre-procedural imaging despite all patients stating improved symptoms.

Conclusion:

This early study supports the safety and efficacy of cryoablation for pain management in low-flow vascular malformations and benign vascular tumors. Complete ablation and or radiographic resolution was not required for symptomatic improvement in the observed population, likely related to locoregional neurolysis. Cryoablation represents a treatment alternative for patients who failed treatment of low flow vascular malformations or benign vascular tumors with sclerotherapy.