Lee B B, Kim D I, Huh S, Kim H H, Choo I W, Byun H S, Do Y S
CVM Clinic, Vascular Center, Samsung Medical Center and the Department of Surgery, Sungkyunkwan University, Seoul, South Korea.
J Vasc Surg. 2001 Apr;33(4):764-72. doi: 10.1067/mva.2001.112209.
Complex forms of congenital venous malformation have defied proper classification and confounded therapy. Through a newly designed multidisciplinary approach, these venous defects were properly diagnosed and classified according to the Hamburg classification. Absolute ethanol was adopted as a new scleroagent for this complex form of venous defects to improve overall treatment results with acceptable morbidity and recurrence rates.
Among 318 patients aged 2 months to 60 years (130 men: mean age, 24.6 years; 188 women: mean age, 24.5 years), 143 patients were confirmed as having venous defects predominantly (45%). We conducted diagnostic evaluation with magnetic resonance imaging, whole body blood pool scan, duplex scans, transarterial microalbumin lung scans, air plethysmography, bone x-ray film, and angiography. Thirty of 143 patients were indicated for the absolute ethanol sclerotherapy for the complex form of venous defects, and they completed 98 sessions of multistage therapy with direct puncture technique. Follow-up assessment (minimum, 6 months; average, 10.2 months) was made as early results after completion of therapy.
The immediate success rate at the completion of treatment through 98 sessions on 30 patients was 92% (90/98). The reason for the failure of 8% (8/98 sessions) was mainly due to the lesion's inaccessibility to the nidus to deliver the alcohol safely. On follow-up assessment available on 28 of 30 patients, overall improvement of the lesions with good to fair response on clinical assessment was obtained in 27 (96%) of 28 patients. Similar good to fair responses were obtained on whole body blood pool scan assessment (14 [93%] of 15 patients) and also on magnetic resonance imaging assessment (12 [93%] of 13 patients). Various major to minor acute complications developed during the procedure in eight (26.7%) of 30 patients through 16 (16.3%) of 98 sessions of the therapy: ischemic bullae, tissue fibrosis, deep venous thrombosis, pulmonary embolism, peripheral nerve palsy, and temporary pulmonary hypertension. All 24 incidences of complication were successfully managed with full recovery except one case of permanent peroneal nerve palsy that was present during 18 months of follow-up. No single recurrence has been detected to date.
Absolute ethanol sclerotherapy alone can deliver excellent results in complex forms of venous malformations with considerable but acceptable morbidity and may be able to reduce the morbidity involved with the conventional surgical therapy alone on complex forms of venous malformation. No recurrence or deterioration of the therapy results was observed during the follow-up period (average, 10.2 months) after the completion of multistaged therapy.
复杂形式的先天性静脉畸形难以进行恰当分类，且使治疗陷入困境。通过一种新设计的多学科方法，这些静脉缺陷依据汉堡分类法得到了正确诊断和分类。采用无水乙醇作为治疗这种复杂形式静脉缺陷的新型硬化剂，以提高总体治疗效果，同时使发病率和复发率处于可接受范围。
在318例年龄从2个月至60岁的患者中（男性130例，平均年龄24.6岁；女性188例，平均年龄24.5岁），143例患者被确诊主要患有静脉缺陷（45%）。我们采用磁共振成像、全身血池扫描、双功扫描、经动脉微量白蛋白肺扫描、空气容积描记法、骨X线片及血管造影进行诊断评估。143例患者中有30例因复杂形式的静脉缺陷而接受无水乙醇硬化治疗，他们采用直接穿刺技术完成了98次多阶段治疗。在治疗完成后进行了随访评估（最短6个月，平均10.2个月）以获取早期结果。
通过对30例患者进行98次治疗，治疗结束时的即刻成功率为92%（90/98）。8%（8/98次治疗）失败的原因主要是病变的病灶难以触及，无法安全注射乙醇。在30例患者中的28例可进行随访评估，28例患者中有27例（96%）病变总体改善，临床评估反应良好至中等。在全身血池扫描评估中（15例患者中的14例[93%]）以及磁共振成像评估中（13例患者中的12例[93%]）也获得了类似的良好至中等反应。在30例患者中的8例（26.7%）通过98次治疗中的16次（16.3%）治疗过程中出现了各种严重程度不一的急性并发症：缺血性大疱、组织纤维化、深静脉血栓形成、肺栓塞、周围神经麻痹及短暂性肺动脉高压。除1例在18个月随访期间出现永久性腓总神经麻痹外，所有24例并发症均成功处理且完全康复。迄今为止未检测到复发情况。
单独使用无水乙醇硬化治疗可在复杂形式的静脉畸形中取得优异效果，发病率虽高但在可接受范围内，且可能降低单纯采用传统手术治疗复杂形式静脉畸形所涉及的发病率。在多阶段治疗完成后的随访期（平均10.2个月）内未观察到治疗结果的复发或恶化情况。
