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SIR 2026

Scientific Session

Venous Interventions

Session: Vascular Malformations

258 - MR-guided Cryoablation for Treatment of Painful Large to Medium Vascular Malformations in the Plantar Foot – a Retrospective Study

Tuesday, April 14, 2026
3:18 PM - 3:27 PM ET
Purpose: To evaluate the safety and efficacy of MR-guided cryoablation for treating painful vascular malformations of the plantar foot.

Materials and Methods: An institutional review board-approved retrospective review was undertaken of all pediatric and adult patients who underwent MR-guided cryoablation for treatment of symptomatic plantar foot vascular malformations. Ultrasound/MR imaging was used for probe placement and to monitor ice-ball formation. Lesion dimensions, number of ablation sessions, number of freeze-thaw cycles, recurrence rates, and MR imaging features were recorded. Pain was assessed with a visual analog scale (VAS, 0–10) or self-reported symptomatic improvement.

Results: Twenty-four patients (17 females, 7 males; mean age 32.1 years, range 10-85 years) were treated between 2015 and 2025 for painfully symptomatic plantar vascular malformation. Of these patients, 10 (41.7%) had failure of prior procedures including sclerotherapy or surgical resection. On average, 3 freeze-thaw cycles (range 2-5) were performed in each cryoablation. A total of 35 ablation sessions were performed. The mean lesion size was 4.4 x 2.5 x 3.9 cm and the maximum diameter reported was 10.5 cm. All lesions demonstrated good MRI visibility with increased T2-weighted intensity with most patients being treated for pain and 1 patient had an additional indication of reducing the vascular malformation size to control bleeding prior to their orthopedic surgery. Clinical follow-up was available for 22 patients. At the 6-month follow-up, 18 of the 22 patients (81.8%) reported significant pain relief. Three of the 22 (13.6%) patients experienced pain recurrence, one of whom was successfully treated with a second ablation session. The other two patients had persistent pain despite three ablation sessions, carried out at 2 to 3-year intervals. Four patients of the 18 (22.2%) patients who initially had pain relief at 6 months developed new pain at the 12-month follow-up. Two of these 4 patients were successfully treated with a second ablation, while the other two were lost to follow-up. One patient who did not have a 6-month follow-up showed pain relief at the 12-month follow-up. Minor complications occurred in 8 out of the 22 patients (36.3%) including paresthesia that resolved after a few months, swelling which was managed with compression stocking, and stress fractures managed conservatively.

Conclusion: MR-guided cryoablation is a safe and effective minimally invasive procedure for symptom control of plantar vascular malformations and management of recurrent lesions.