Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
Diagn Interv Radiol. 2011 Dec;17(4):363-7. doi: 10.4261/1305-3825.DIR.3808-10.0. Epub 2011 Jan 4.
To review the therapeutic results of the combination of embolization and sclerotherapy, with or without surgery, in patients with peripheral vascular malformations (PVMs).
A total of 40 patients (24 males and 16 females) with PVMs, who were treated via percutaneous embolization (transarterial [TA] versus direct puncture [DP]) and sclerotheraphy between March 2003 and September 2009, were included in this retrospective study. The mean age was 28 years (range, 6-66 years), and 9 patients (7 boys, 2 girls) were ≤18 years of age (range, 6-18 years). The 40 patients experienced 40 PVMs, of which 15 were localized to an upper extremity, 13 to a lower extremity, 7 to the axial body, and 5 to the pelvis. A total of 22 PVMs were high-flow, whereas 18 were low-flow. Indications for treatment included pain, swelling, extremity function loss, and cosmetic concerns.
A total of 85 embolization/sclerotheraphy sessions were performed (2.1 sessions per patient). For the 22 high-flow PVMs, 53 treatment sessions were completed (2.4 sessions per lesion). Of the high-flow PVMs, 10 were treated via embolization only (7 DP, 2 TA, 1 DP and TA), 5 via alcohol sclerotheraphy only (2 DP, 2 TA, 1 DP and TA) and 7 via a combination of embolization and sclerotheraphy (3 TA, 4 DP and TA). The agents of embolization and sclerotherapy were n-butyl cyanoacrylate (n=22 patients), Onyx® (n=12 patients), and alcohol (n=19 patients). A total of 18 low-flow PVMs were treated in 32 sessions (1.8 sessions per lesion), all via the direct puncture approach. Of the low-flow PVMs, 11 were treated with embolization only, 6 with sclerotheraphy only, and 1 with a combined approach. In 16 patients (6 high-flow versus 10 low-flow), after a mean of 2.1 sessions (range, 1-9 sessions), the percutaneously treated lesions were excised by surgery without any major complications. In the 24 patients who did not have surgery, the lesions significantly decreased in size and the complaints from these patients improved. In four patients, skin ulcerations were identified, two of these patients needed surgical grafting; whereas in one patient, sciatic nerve paralysis developed after trans-arterial embolization and recovery was achieved in six months.
Percutaneous treatment of PVMs by embolization and sclerotheraphy is a safe and effective method, provided that appropriate lesion classification and treatment agent selection are performed.
回顾栓塞和硬化疗法联合治疗（有或无手术）外周血管畸形（PVM）患者的治疗效果。
2003 年 3 月至 2009 年 9 月，共对 40 例（24 名男性和 16 名女性）PVM 患者进行了经皮栓塞（经动脉[TA]与直接穿刺[DP]）和硬化治疗，纳入本回顾性研究。平均年龄 28 岁（范围 6-66 岁），9 例（7 名男孩，2 名女孩）≤18 岁（范围 6-18 岁）。40 例患者共经历 40 次 PVM 治疗，其中 15 例位于上肢，13 例位于下肢，7 例位于轴体，5 例位于骨盆。22 例 PVM 为高流量，18 例为低流量。治疗指征包括疼痛、肿胀、肢体功能丧失和美容问题。
共进行了 85 次栓塞/硬化治疗（每个患者 2.1 次）。对于 22 例高流量 PVM，共完成了 53 次治疗（每个病变 2.4 次）。在高流量 PVM 中，有 10 例仅接受栓塞治疗（7 例 DP，2 例 TA，1 例 DP 和 TA），5 例仅接受酒精硬化治疗（2 例 DP，2 例 TA，1 例 DP 和 TA），7 例接受栓塞和硬化治疗联合治疗（3 例 TA，4 例 DP 和 TA）。栓塞和硬化治疗的药物有 n-丁基氰丙烯酸酯（n=22 例）、Onyx®（n=12 例）和酒精（n=19 例）。18 例低流量 PVM 共接受 32 次治疗（每个病变 1.8 次），均采用直接穿刺方法。在低流量 PVM 中，11 例仅接受栓塞治疗，6 例仅接受硬化治疗，1 例接受联合治疗。在 16 例患者（6 例高流量与 10 例低流量）中，在平均 2.1 次（范围 1-9 次）治疗后，经皮治疗的病变通过手术切除，无重大并发症。在未进行手术的 24 例患者中，病变显著缩小，这些患者的症状得到改善。4 例患者出现皮肤溃疡，其中 2 例需要手术植皮，1 例患者经动脉栓塞后出现坐骨神经麻痹，6 个月后恢复。
通过栓塞和硬化治疗对外周血管畸形进行经皮治疗是一种安全有效的方法，前提是进行适当的病变分类和治疗药物选择。
