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
physical disability http
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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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