Sclerotherapy for vascular malformations: complications and a review of techniques to avoid them.

PURPOSE: Interventional radiology has a principal role frequently replacing surgery in the multidisciplinary management of vascular malformations. Having noticed an initial high rate of complications, we examined our early experience to study in detail the outcomes and risks. We also present a review of techniques to reduce these complications.
MATERIALS AND METHODS: Data were collected during a 5-year period on patients who had completed treatment. The two sclerosants used were either 100% alcohol or 3% sodium tetradecyl sulphate (STS) as sole agents, or in combination. We graded early clinical and radiological outcomes. Binary logistic regression analysis was carried out for variables (age, type of vascular malformation and number of sclerotherapy sessions) that may predict the occurrence of complications.
RESULTS: Twenty-four patients (11 males and 13 females) completed treatment during this period and were the subject of this review. There were a total of 46 sessions with an average of two (range: one to five). The mean and median ages were 36.2 and 38 years, respectively. Nineteen patients had venous malformations and five had lymphatic malformations. Most of the vascular malformations were in the head and neck region (66.7%). Although the overall early results were favourable (21 out of 24 patients had partial or complete resolution clinically and radiologically), there were four nerve-related and three skin-related complications. Using alcohol alone (13 patients, 24 sessions) there were one skin and three nerve injuries; with STS alone (five patients, 19 sessions) there was one skin complication; and when in combination (six patients, three sessions) one nerve and one skin complications.
CONCLUSION: More complications were seen with the use of alcohol, including all the nerve-related injuries, prompting a change of practice to favour STS as the primary agent, especially for head and neck lesions.