Efficacy of sclerotherapy with radio-opaque foam guided by digital subtraction angiography for the treatment of complex venous malformations of the head and neck.

Our aim was to evaluate the efficacy of sclerotherapy using radio-opaque foam and guided by digital subtraction angiography (DSA) for complex venous malformations in the head and neck in 11 selected patients between 2011 and 2013. The sclerosing foam was manufactured by the classic Tessari method and consisted of air, 1% polidocanol, and radio-opaque media iopromide (Ultravist(®)300) in a ratio of 7:2:1. We recorded the site and size of the lesion, time and duration of treatment, and therapeutic response. The lesions were on the face, cheek, temporal region, parotid region, neck, tongue, floor of the mouth, parapharyngeal space, and soft palate. The sclerosing foam was radio-opaque under DSA, and the mean (range) dose was 21 (3-65) ml. A mean (range) of 4 (2-7) treatments was required, and 10 of the 11 patients responded well. In 4 of the 11 cases the lesion resolved completely and in 6 there was a good response. Only one lesion recurred. Early complications included immediate swelling in injected areas, snoring, and pain on swallowing, but there were no air emboli or signs of cutaneous necrosis, and the complications were self-limiting. DSA-guided sclerotherapy with radio-opaque foam was safe and effective for the treatment of complex vascular malformations of the head and neck.