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CardioVascular and Interventional Radiology

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01-10-2018 | Clinical Investigation

Intramuscular Venous Malformations of the Upper and Lower Limbs: Indications and Outcomes of Sclerotherapy

Authors: Giuseppe Bianchini, Daniele Camilli, Sergio Furgiuele

Published in: CardioVascular and Interventional Radiology | Issue 10/2018

Abstract

Purpose

Multiple treatment options have been described for intramuscular venous malformations (VMs) of the limbs. At the current time, there are no clear management guidelines. The aim was to evaluate efficacy and safety of sclerotherapy in this type of VMs.

Materials and Methods

This is a single-center, retrospective review of patients treated for extremity intramuscular VMs between January 2013 and June 2017. The primary outcomes were the improvement of symptoms self-assessed by questionnaires, and the reduction in VM size measured by magnetic resonance (MRI).

Results

Sclerotherapy was performed in 81 patients with extremity intramuscular VMs. The sclerosing agent was ethanol in 46 cases (56.8%), polidocanol in 27 cases (33.3%), a combination of both in 8 cases (9.9%). The mean follow-up was 26 months (range 3–52). Overall quality of life was improved in 62 patients (76.5%). The postoperative MRI showed a minimum change of VM size in 68 patients (83.9%). A major complication (peripheral nerve injury) was observed in 1 case (1.2% of patients, 0.5% of procedures). Minor complications occurred in 9 cases (11.1% of patients, 4.1% of procedures).

Conclusions

Sclerotherapy is a low-invasive, effective and safe treatment for intramuscular VMs of the extremities. It induces a significant improvement in symptoms, also when the VM size is unchanged.

Level of Evidence

Level 4, Case Series.

Lesions were graded with MR imaging on the basis of margins and size, respectively: grade 1, well defined, less than or equal to 5 cm; grade 2A, well defined, greater than 5 cm; grade 2B, ill defined, less than or equal to 5 cm; and grade 3, ill defined, greater than 5 cm.

Greene AK, Liu AS, Mulliken JB, Chalache K, Fishman SJ. Vascular anomalies in 5621 patients: guidelines for referral. J Pediatr Surg. 2011;46:1784–9.CrossRefPubMed

Wieck MM, Nowicki D, Schall KA, Zeinati C, Howell LK, Anselmo DM. Management of pediatric intramuscular venous malformations. J Pediatr Surg. 2017;52:598–601.CrossRefPubMed

Vogel SA, Hess CP, Dowd CF, Hoffman WY, Kane AJ, Rajaii R, Frieden IJ. Early versus later presentations of venous malformations: where and why? Pediatr Dermatol. 2013;30:534–40.CrossRefPubMed

Hassanein AH, Mulliken JB, Fishman SJ, Alomari AI, Zurakowski D, Greene AK. Venous malformation: risk of progression during childhood and adolescence. Ann Plast Surg. 2012;68:198–201.CrossRefPubMed

Mendonca DA, McCafferty I, Nishikawa H, Lester R. Venous malformations of the limbs: the Birmingham experience, comparisons and classification in children. J Plast Reconstr Aesthet Surg. 2010;63:383–9.CrossRefPubMed

Hein KD, Mulliken JB, Kozakewich HP, Upton J, Burrows PE. Venous malformations of skeletal muscle. Plast Reconstr Surg. 2002;110:1625–35.CrossRefPubMed

Rivas S, Lopez-Gutierrez JC, Diaz M, Andrès AM, Ross Z. Venous malformations. diagnosis and treatment during the childhood. Cir Pediatr. 2006;19:77–80.PubMed

Jung HC, Kim DH, Park BK, Park MK. Extensive intramuscular venous malformation in the lower extremity. Ann Rehabil Med. 2012;36:893–6.CrossRefPubMed

Domb BG, Khanna AJ, Mitchell SE, Frassica FJ. Toe-walking attributable to venous malformation of the calf muscle. Clin Orthop Relat Res. 2004;420:225–9.CrossRef

10.

Gorriz E, Carreira JM, Reyes R, Gervàs C, Pulido JM, Pardo MD, Maynar M. Intramuscular low flow vascular malformations: treatment by means of direct percutaneous embolization. Eur J Radiol. 1998;27:161–5.CrossRefPubMed

11.

Rabe E, Pannier F. Sclerotherapy in venous malformation. Phlebology. 2013;28:188–91.CrossRefPubMed

12.

Childs DD, Emory CL. Successful treatment of intramuscular venous malformation with image-guided radiofrequency ablation. J Vasc Interv Radiol. 2012;23:1391–3.CrossRefPubMed

13.

Cornelis FH, Labrèze C, Pinsolle V, Le Bras Y, Castermans C, Bader C, Thiebaut R, Midy D, Grenier N. Percutaneous image-guided cryoablation as second-line therapy of soft-tissue venous vascular malformations of extremities: a prospective study of safety and 6-month efficacy. Cardiovasc Intervent Radiol. 2017;40:1358–66.CrossRefPubMed

14.

van der Vleuten CJ, Kater A, Wijnen MH, Schultze Kool LJ, Rovers MM. Effectiveness of sclerotherapy, surgery, and laser therapy in patients with venous malformations: a systematic review. Cardiovasc Intervent Radiol. 2014;37:977–89.PubMed

15.

Cohen SR, Mount BM, Tomas JJ, Mount LF. Existential wellbeing is an important determinant of quality of life. evidence from the McGill quality of life questionnaire. Cancer. 1996;77:576–86.CrossRefPubMed

16.

Goyal M, Causer PA, Armstrong D. Venous vascular malformations in pediatric patients: comparison of results of alcohol sclerotherapy with proposed MR imaging classification. Radiology. 2002;223:639–44.CrossRefPubMed

17.

Yun WS, Kim YW, Lee KB, Kim DI, Park KB, Kim KH, Do YS, Lee BB. Predictors of response to percutaneous ethanol sclerotherapy (PES) in patients with venous malformations: analysis of patient self-assessment and imaging. J Vasc Surg. 2009;50:581–9.CrossRefPubMed

18.

Nakamura M, Osuga K, Maeda N, Higashihara H, Hamada K, Hashimoto N, Uehara S, Tomiyama N. Percutaneous sclerotherapy for venous malformations in the extremities: clinical outcomes and predictors of patient satisfaction. Springer Plus. 2014;3:520.CrossRefPubMed

19.

Kim EY, Ahn JM, Yoon HK, Suh YL, Do YS, Kim SH, Choo SW, Choo IW, Kim SM, Kang HS. Intramuscular vascular malformations of an extremity: findings on MR imaging and pathologic correlation. Skeletal Radiol. 1999;28:515–21.CrossRefPubMed

20.

Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R. Venous malformations: clinical diagnosis and treatment. Cardiovasc Diagn Ther. 2016;6:557–69.CrossRefPubMedPubMedCentral

21.

Lee BB, Baumgartner I, Berlien P, Bianchini G, Burrows P, Gloviczki P, Huang Y, Laredo J, Loose DA, Markovic J, Mattassi R, Parsi K, Rabe E, Rosenblatt M, Shortell C, Stillo F, Vaghi M, Villavicencio L, Zamboni P. Diagnosis and treatment of venous malformations consensus document of the international union of phlebology (IUP): updated 2013. Int Angiol. 2015;34:97–149.PubMed

22.

Upton J, Coombs CJ, Mulliken JB, Burrows PE, Pap S. Vascular malformations of the upper limb: a review of 270 patients. J Hand Surg Am. 1999;24:1019–35.CrossRefPubMed

23.

Stuart S, Barnacle AM, Smith G, Pitt M, Roebuck DJ. Neuropathy after sodium tetradecyl sulfate sclerotherapy of venous malformations in children. Radiology. 2015;274:897–905.CrossRefPubMed

24.

Rautio R, Saarinen J, Laranne J, Salenius JP, Keski-Nisula L. Endovascular treatment of venous malformations in extremities: results of sclerotherapy and the quality of life after treatment. Acta Radiol. 2004;45:397–403.CrossRefPubMed

25.

van der Linden E, Pattynama PM, Heeres BC, de Jong SC, Hop WC, Kroft LJ. Long-term patient satisfaction after percutaneous treatment of peripheral vascular malformations. Radiology. 2009;251:926–32.CrossRefPubMed

26.

Qiu Y, Chen H, Lin X, Hu X, Jin Y, Ma G. Outcomes and complications of sclerotherapy for venous malformations. Vasc Endovascular Surg. 2013;47:454–61.CrossRefPubMed

27.

Gurgacz S, Zamora L, Scott NA. Percutaneous sclerotherapy for vascular malformations: a systematic review. Ann Vasc Surg. 2014;28:1335–49.CrossRefPubMed

28.

Teusch VI, Wohlgemuth WA, Hammer S, Piehler AP, Müller-Wille R, Goessmann H, Uller W. Ethanol-gel sclerotherapy of venous malformations: effectiveness and safety. AJR Am J Roentgenol. 2017;209:1390–5.CrossRefPubMed

29.

Chewning R, Lindberg A, Monroe E, Vaidya S, Shivaram G. Glue embolization of pediatric non-head and neck venous malformations. J Vasc Interv Radiol. 2016. https://doi.org/10.1016/j.jvir.2015.12.490.CrossRef

30.

Steiner F, FitzJohn T, Tan ST. Ethanol sclerotherapy for venous malformation. ANZ J Surg. 2016;86:790–5.CrossRefPubMed

31.

Guevara CJ, Gonzalez-Araiza G, Kim SK, Sheybani E, Darcy MD. Sclerotherapy of diffuse and infiltrative venous malformations of the hand and distal forearm. Cardiovasc Intervent Radiol. 2016;39:705–10.CrossRefPubMed

32.

Burrows PE. Endovascular treatment of slow-flow vascular malformations. Tech Vasc Interv Radiol. 2013;16(1):12–21.CrossRefPubMed

33.

Asdahl KR, Hedelund L, Keller J, Baad-Hansen T, Damsgaard T. Outcome measures after sclerotherapy of venous malformations: a systematic review. Cardiovasc Intervent Radiol. 2018. https://doi.org/10.1007/s00270-018-1919-y.PubMedCrossRef

Title: Intramuscular Venous Malformations of the Upper and Lower Limbs: Indications and Outcomes of Sclerotherapy
Authors: Giuseppe Bianchini
Daniele Camilli
Sergio Furgiuele
Publication date: 01-10-2018
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 10/2018
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-018-1997-x

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Springer Medicine

Intramuscular Venous Malformations of the Upper and Lower Limbs: Indications and Outcomes of Sclerotherapy

Abstract

Purpose

Materials and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusions

Level of Evidence

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