Li Long, Feng Jie, Zeng Xin-Qiao, Li Yan-Hao
Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
J Vasc Surg. 2009 Apr;49(4):961-7. doi: 10.1016/j.jvs.2008.10.037.
Ultrasound-guided foam sclerotherapy is a generally safe, cost-effective, and practical technique for the treatment of certain venous malformations; however, not all vascular malformation lesions are amenable to the ultrasound-guided method. Venous outflow of the sclerosing agent and extravasation are difficult to check when only ultrasound guidance is used. This study describes a new fluoroscopy-guided technique that uses standardized sclerosing foam for peripheral venous malformations. The short-term efficacy and safety of fluoroscopy-guided foam sclerotherapy for peripheral venous malformations was evaluated.
A retrospective review of a prospectively collected data was performed for 23 patients (9 males, 14 females) with limited (localized) venous malformations treated with foam sclerotherapy who were referred from January 2007 to December 2007. Median patient age was 21 years (range, 5 months-39 years). Lesion locations included extremities in 13, faces in eight, and trunks in two. The standardized sclerosing foam was prepared using Tessari's method to mix room air with 5% sodium morrhuate in a 4:1 ratio. Sclerotherapy was performed by the "filling-defects" technique under fluoroscopy. Postsclerotherapy surveillance was done at 6 months after the last session. Treatment response was assessed clinically and by means of lesion size measurement with magnetic resonance imaging. During the treatment and the follow-up period, adverse events and adverse drug reactions were recorded. Specific complications were classified as major or minor.
A total of 58 treatment sessions were performed (mean, 3 sessions per patient; range, 1-6 sessions). At the 6-month follow-up, 15 patients (65.2%) showed a total disappearance of treated malformations, six (26.1%) showed a reduction in malformation size of >50%, and two (8.7%) showed a reduction in malformation size of </=50%. The overall patient-reported outcome was excellent in 11 (47.8%), good in 8 (34.8%), or moderate in 4 (17.4%). Minor complications included swelling and inflammatory reaction per session, mild pain in 17 sessions (29.3%), and skin blister at the injection site in two sessions (3.4%), which resolved spontaneously within several days to 2 weeks. No major complications occurred.
Fluoroscopic guidance could have great promise in foam sclerotherapy of peripheral venous malformations, although larger studies are necessary to determine the advantages of this technique over other sclerotherapeutic methods.
超声引导下泡沫硬化疗法是治疗某些静脉畸形的一种普遍安全、经济有效且实用的技术；然而，并非所有血管畸形病变都适合超声引导方法。仅使用超声引导时，硬化剂的静脉流出和外渗难以检查。本研究描述了一种新的透视引导技术，该技术使用标准化硬化泡沫治疗周围静脉畸形。评估了透视引导下泡沫硬化疗法治疗周围静脉畸形的短期疗效和安全性。
对2007年1月至2007年12月转诊的23例（9例男性，14例女性）接受泡沫硬化疗法治疗的局限性（局部性）静脉畸形患者进行前瞻性收集数据的回顾性分析。患者中位年龄为21岁（范围5个月至39岁）。病变部位包括13例在四肢，8例在面部，2例在躯干。使用泰萨里方法制备标准化硬化泡沫，将室内空气与5%鱼肝油酸钠按4:1比例混合。在透视下通过“充盈缺损”技术进行硬化疗法。在最后一次治疗后6个月进行硬化疗法后监测。通过临床评估和磁共振成像测量病变大小来评估治疗反应。在治疗和随访期间，记录不良事件和药物不良反应。特定并发症分为严重或轻微。
共进行了58次治疗（平均每位患者3次；范围1至6次）。在6个月随访时，15例患者（65.2%）治疗的畸形完全消失，6例（26.1%）畸形大小缩小>50%，2例（8.7%）畸形大小缩小≤50%。患者总体报告的结果为优11例（47.8%），良8例（34.8%），中4例（17.4%）。轻微并发症包括每次治疗出现肿胀和炎症反应、17次治疗出现轻度疼痛（29.3%）、2次治疗在注射部位出现皮肤水泡（3.4%），均在数天至2周内自行缓解。未发生严重并发症。
透视引导在周围静脉畸形的泡沫硬化疗法中可能有很大前景，尽管需要更大规模的研究来确定该技术相对于其他硬化治疗方法的优势。
