BACKGROUND. Although surgical extirpation is the standard method for the tr
eatment of vascular malformations, this procedure often leads to loss of mo
tor function, nerve damage, and massive bleeding if the excision is extensi
ve. Sclerotherapy is an alternative method of treatment for venous malforma
tions.
OBJECTIVE. This study was conducted to assess the effect of color duplex ul
trasound-guided sclerotherapy on venous malformations and the coagulability
induced by sclerosing solution.
METHODS. Twenty-eight patients with venous malformations underwent percutan
eous sclerotherapy by direct puncture under duplex ultrasound guidance. Int
ravenous catheters were inserted into duplex ultrasound-confirmed venous sp
aces and fine plastic tubing filled with normal saline was attached to the
needle. When the needle tip was observed to pierce the vein wall, aspiratio
n of the blood confirmed its intraluminal position. The mean volume of 3.6
mi of 3% polidocanol was injected. Subfascial ligation of the lateral margi
nal venous collector was performed in patients with Klippel-Trenaunay syndr
ome. D-dimer (DD) and thrombin-antithrombin III (TAT) were measured preoper
atively and on the first and fifth postoperative days.
RESULTS. The head and neck, which was the most common site of venous malfor
mations were involved in 57% of the patients. Venous malformations disappea
red in 44% of the patients and decreased in 28%. Localized pain was the mos
t common complication, occuring in 82% of the patients. Sclerotherapy for v
enous malformations produced significant swelling in 75% of the patients, w
hich required 5-7 days to subside. Significant differences were detected in
both DD and TAT concentrations on the first and fifth postoperative days.
CONCLUSIONS. Color duplex-guided sclerotherapy was effective in 82% of the
patients. This procedure prevents intra-arterial injection accidents. Altho
ugh patients with venous malformations showed greater coagulability, no ser
ious thrombotic sequelae were found.