Color duplex-guided sclerotherapy for the treatment of venous malformations

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.