Department of Pediatric Surgery and Oncology Laboratory for Vascular Anomalies Medical University of...

Department of Pediatric Surgery and OncologyLaboratory for Vascular Anomalies

Medical University of Lodz

Foam sclerotherapy in treatment of venous malformations

in children.

Tutor: Assoc. Prof. Przemysław Przewratil MD, PhD

Michał Kowalczyk

International Society for the Study of Vascular Anomalies

ISSVA Classification

V A S C U L A R A N O M A L I E S

TUMORS MALFORMATIONS

Infantile haemangioma

Low-flow Fast-Flow

Venous malformation (VM)

Arterial malformation (AM)

Capillary malformation (CM) Arteriovenous fistula (AVF)

Lymphatic malformation (LM)

Arteriovenous malformation (AVM)

Venous malformation

• lesion composed of abnormal collections of veins

• mostly localized in the skin

• can affect any other tissue or organ

• cutaneous and subcutaneous tissue

• muscles

• joints

• intestines

• most frequent low-flow vascular malformations

• may cause cosmetic or functional defects as well as

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Venousmalformations

Dubois and Puig Classification

Orthop Clin N Am 2006, 37, 435-474

• A percutaneous injection of a

sclerosing substance directly into a

lesion.

• Prior to injection the sclerosing agent

is mixed with air to make a foam.

• Sclerosant agent causes obliterationhttp

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of the vessel, what effects in sealing off the blood flow.

• It may be administered as an only procedure or in combination with surgical resection.

• Multiple sessions are often required to achieve visual improvement or permanent results.

Foam sclerotherapy

Analysis of the results of the treatment

of venous malformations using foam

sclerotherapy.

Aim of a study

Retrospective analysis

• 34 patients treated between June 2006 and December 2011

• 20 female (59%), 14 male (41%)

• Age range: 1-15 (average 7 years)

Foam sclerotherapy

• Polidocanol (Aethoxysclerol) 1% / 3% | 1 – 6ml

Assessment by US, MRI

Phlebography

• Performed prior to the sclerotherapy in 19 patients (56%)

Surgical resection

• Preceded by sclerotherapy - 6 patients (18%)

Duration of hospital stay – ranged from 1 to 5 days (average 2,5)

Material & Methods

VM Localization

Face

Feet

ThighHan

d

Oral Cav

ityNeck

AbdomenBreast

Forearm Ear

Back

0

2

4

6

8

10

12

14

16

18

Demonstrative pictures

• 4 years old boy

• VM of right hand

MRI

Phlebography

Approach to the VM

BEFORE

AFTER

BEFORE

AFTER03.03.2011

12.09.2011

Foam sclerotherapy

Indications

• Function impairment

• Distortion of anatomical landmarks

• Thrombosis

• Pain

• Cosmetic

Results

4 grade scale of clinical assessment

Outcome Lesion regression

Very good 80-100%

Good 60-80%

Moderate 20-50%

Without improvement <20%

Results

26% 53% 15% 6%

Results

Temporary side effects were observed in 2 (6%) patients.

• Vasculitis – 1 case

• Skin necrosis – 1 case

Initial phlebography increased significantly the effectiveness

and safety of each sclerotherapy.

In 6 patients (18%) sclerotherapy preceded the surgical

resection improving their performance.

Adopted method was rated by parents and patients as effective

and hardly invasive.

Conclusions

1. VMs treatment is based on a proper diagnosis according

to ISSVA classification, differentiating them from infantile

hemangiomas.

2. Sclerotherapy with polidaconol used as foam is effective

and safe managment of VMs.

Any Questions?

Thank youfor your attention.

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