Clinical efficacy of absolute ethanol combined with n‑butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation in children

Abstract

The aim of the present retrospective study was to investigate the clinical safety and efficacy of absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy in the treatment of Puig's classified advanced venous malformation. Sclerotherapy was performed in 121 children (52 males and 69 females; age range, 5 months to 16 years) with venous malformations under general anesthesia between April 2009 and October 2014 at the Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China. The patients with venous malformations were diagnosed and classified according to the diagnostic criteria of the International Society for the Study of Vascular Anomalies. According to the characteristics of intraoperative percutaneous angiography, 21 patient cases (9 males and 12 females; age range, 6 months to 14 years) were classified as advanced Puig's venous malformation. These 21 patients were treated with absolute ethanol combined with n-butyl cyanoacrylate. The patients were followed-up for 6–24 months (average, 15 months) after treatment. Following treatment with absolute ethanol combined with n-butyl cyanoacrylate, 15 cases were controlled and the total effective rate was 71% (15/21). However, 1 patient developed skin ulcerations, which was classed as a minor complication, 1 patient developed ectopic embolism caused by n-butyl cyanoacrylate reflux, and 1 patient developed transient pulmonary hypertension, the latter two complications were classified as major. Notably, the incidence rate of minor and major complications were 14.3%. To conclude, the present findings indicated that absolute ethanol combined with n-butyl cyanoacrylate sclerotherapy was a safe and effective method with a low complication rate in the treatment of Puig's classified advanced venous malformation in patients.

Digital Subtraction Angiography-Guided Foam Sclerotherapy with Polidocanol for Treating Superficial Venous Malformation

“…This demographic is similar to that of previous studies such as Lee et al (318 patients,40.8% male and 59.2% female; average age, 24.9), 9) Su et al (average age, 22.9 years), 10) and Li et al (57% male and 43% female). 11) We used Puig s classification to divide venous malformations into four types. This classification is mainly based on the characteristics of the drainage veins.…”

“…This demographic is similar to that of previous studies such as Lee et al (318 patients, 40.8% male and 59.2% female; average age, 24.9), 9 ) Su et al (average age, 22.9 years), 10 ) and Li et al (57% male and 43% female). 11 )…”

“…All patients were hospitalized because of clinical symptoms, such as swelling, pain, limited movement, aesthetics, dysphagia, and shortness of breath, and were diagnosed by ultrasound with a high-frequency flat probe (7)(8)(9)(10)(11)(12)(13)(14)(15). MRI contrast agents were administered to assess the size and extent of lesions.…”

Balloon occlusion as an adjunctive technique during sclerotherapy of Puig's classified advanced venous malformations

“…Although a curative efficacy of 93.5% averaged across our cohort’s Puig type VMs is greater than the 70% reported in recent literature, our small cohort is insufficient to establish true statistical significance correlating the ability of balloon implementation in achieving more total sclerosis in type 2 to 4 VMs. 18 Nevertheless, such a trend towards reducing the total number of sclerotherapy sessions due to more complete outflow vein occlusion via balloon inflation should not be overlooked.…”

“…17 Li et al recently reported a 70% efficacy following combined ethanol and n-butyl cyanoacrylate sclerotherapy of their cohorts' Puig type VMs, higher than 55% curative rates previously reported in the literature. 18 The aim of sclerotherapy is to induce mural irritation of its respective target with subsequent sclerosis, collapse, and eventual pruning of the malformation. In contrast, as embolotherapy results in primary mechanical occlusion while otherwise maintaining the structural integrity of its target, its minimal utilization is preferred to avoid creation of large areas of firm or potentially palpable lumps in the respective regions of the given malformation.…”