Interventional Radiology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy.
Radiol Med. 2018 Jun;123(6):474-480. doi: 10.1007/s11547-018-0869-4. Epub 2018 Feb 23.
The therapeutical management of low-flow vascular malformations (LFVMs) is challenging because of high recurrence rate; multiple strategies have been proposed. This paper aims to report a single-center experience of direct puncture sclerotherapy of peripheral LFVMs, focusing on technical aspects and clinical outcome in mid-term follow-up.
16 patients have been treated for peripheral LFVMs (mean age 36.1 years), complaining mild pain, swelling of the region of interest, and cosmetic nuisance. Preprocedural US and MR were acquired; angiography performed only in doubt vascular supply. Standard procedure consisted of direct puncture of the nidus using 20-23 gauge needles under US guidance and injection of up to 15 ml foam of sodium tetradecyl sulphate under fluoroscopic guidance. Clinical and radiological follow-up were assessed at 1, 3, and 6 months.
Lesions were localized: 8 in the upper and 5 the in lower limbs, 2 in the cheeks, and 1 in the vaginal labia. All procedures have been technically accomplished (100%). At 6 month follow-up, technical and clinical success were obtained in all cases, while radiological follow-up showed 81.2% (13 patients) complete vessels thrombosis after multiple sclerotherapy sessions. No major complications have been recorded; five patients (31.2%) referred minor complications.
Sclerotherapy via direct puncture of LFVMs is a clinically effective procedure, well tolerated by patients, with reduced costs and mild minor complications rate; interventionalists should always clarify to the patients that multiple sessions would be performed and recurrences are expected at imaging follow-up despite clinical improvement.
低流量血管畸形（LFVM）的治疗管理具有挑战性，因为其复发率高；已经提出了多种策略。本文旨在报告单一中心的外周 LFVM 直接穿刺硬化治疗经验，重点关注中期随访中的技术方面和临床结果。
16 名患者因外周 LFVM（平均年龄 36.1 岁）接受治疗，这些患者抱怨有轻度疼痛、感兴趣区域肿胀和美容烦恼。在进行治疗前获取了超声和磁共振成像（MRI）；仅在怀疑有血管供应时才进行血管造影。标准程序包括在超声引导下使用 20-23 号针直接穿刺病灶，并在透视引导下注射多达 15ml 的十四烷基硫酸钠泡沫。在 1、3 和 6 个月时进行临床和放射学随访。
病变部位分别位于上肢 8 处、下肢 5 处、面颊 2 处和阴道阴唇 1 处。所有的操作都可以在技术上完成（100%）。在 6 个月的随访中，所有病例均获得了技术和临床成功，而放射学随访显示在多次硬化治疗后，13 例（81.2%）患者的血管完全血栓形成。未记录到重大并发症；有 5 名患者（31.2%）报告有轻微并发症。
通过直接穿刺 LFVM 进行硬化治疗是一种临床有效的方法，患者耐受性良好，成本降低，轻微并发症发生率低；介入医生应始终向患者说明，尽管临床症状改善，但仍需要进行多次治疗，并预期在影像学随访中会出现复发。
