Shirai H, Imai S, Kajihara Y, Yamashita T, Goto T, Tokiya R, Koshima I, Moriguchi T
Department of Diagnostic Radiology, Kawasaki Medical School.
Nihon Igaku Hoshasen Gakkai Zasshi. 1999 Jun;59(7):325-32.
Peripheral vascular lesions may occur as a result of various clinical problems, cosmetic or dysfunctional causes, or bleeding. In severe cases, coagulopathy and congestive heart failure may occur. Although the efficacy of transarterial embolization (TAE) for arterial vascular lesions is well known, TAE has no effect on low-flow vascular lesions (venous malformations, venous angiomas, and venous components of arteriovenous malformation). Therefore, in such cases, a percutaneous approach is the best method, and we consider sclerotherapy to be the most useful conservative treatment. The primary objective of this study was to confirm the efficacy of percutaneous sclerosing treatment for peripheral low-flow vascular lesions. Lesions were classified on the basis of state of blood flow and morphologic features, and infiltration was classified on the basis of angiographic features and magnetic resonance imaging (MRI) findings. In sclerosing treatment, we used 5% solutions of polidocanol, absolute ethanol, and N-butyl-2-cyanoacrylate (NBCA) as sclerosing agents. Each type of lesion, static or slow-flow, cystic, or localized, showed remarkable improvement after sclerosing treatment with only polidocanol. However, for moderate-to-fast-flow lesions, another sclerosing agent (absolute ethanol/NBCA) was needed. With diffuse infiltrative lesions, surgical repair might be needed, but we recognize the usefulness of sclerosing treatment for functional or cosmetic improvement in these cases.
外周血管病变可能由各种临床问题、美容或功能障碍原因或出血引起。在严重情况下，可能会发生凝血病和充血性心力衰竭。尽管经动脉栓塞术（TAE）对动脉血管病变的疗效是众所周知的，但TAE对低流量血管病变（静脉畸形、静脉血管瘤以及动静脉畸形的静脉成分）无效。因此，在这种情况下，经皮治疗方法是最佳选择，我们认为硬化疗法是最有用的保守治疗方法。本研究的主要目的是证实经皮硬化治疗对外周低流量血管病变的疗效。根据血流状态和形态学特征对病变进行分类，并根据血管造影特征和磁共振成像（MRI）结果对浸润情况进行分类。在硬化治疗中，我们使用聚多卡醇5%溶液、无水乙醇和氰基丙烯酸正丁酯（NBCA）作为硬化剂。每种类型的病变，无论是静态或缓慢血流、囊性或局限性病变，仅用聚多卡醇进行硬化治疗后均显示出显著改善。然而，对于中到快速血流的病变，则需要另一种硬化剂（无水乙醇/NBCA）。对于弥漫性浸润性病变，可能需要手术修复，但我们认识到在这些情况下硬化治疗对功能或美容改善的有用性。
