Arasakumar Donald Rubakan Benedict, Pang Calver, Evans Nicholas, Papadopoulou Anthie, Khalifa Mohamed, Tsui Janice, Hamilton George, Brookes Jocelyn, Lim Chung Sim
Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom.
Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom.
J Vasc Surg Venous Lymphat Disord. 2023 Mar;11(2):379-388. doi: 10.1016/j.jvsv.2022.10.008. Epub 2022 Oct 31.
We have assessed the efficacy and safety of interventional therapy for venous malformations (VMs), with foam sclerotherapy as the treatment of choice according to our experience at a single specialist center.
All the patients with VMs who had undergone interventional therapy (ie, embolo-sclerotherapy and/or open surgery) from January 1, 2015 to December 31, 2019 were identified through a prospective database. The VM types were classified according to the Puig classification. The outcome measures assessed included the efficacy and complications. The former was divided into four groups: no response, mild response, moderate response, and complete response. The complications were defined as any tissue or functional damage, distal embolization, or tissue reaction. The continuous variables were compared using the analysis of variance F test, and discrete variables were analyzed using the χ tests. P values < .05 were considered statistically significant.
A total of 207 patients were included. Puig type I lesions were significantly less likely to have received foam sclerotherapy using sodium tetradecyl sulfate (STS) 3% (P ≤ .001) and more likely to have been surgically excised (P ≤ .001). At the patient's first procedure during the study period, the volumes of foam STS 3% were significantly different across all types of VM (P ≤ .001). The patients with type I VMs had received a lower volume of STS 3% compared with those with type II and III VMs. The efficacy outcome categories were significantly different across all types of VMs (P ≤ .001). Overall, only 14 patients (6.8%) had reported no improvement in efficacy, and 38 patients (18%) had not attended follow-up. Therefore, 154 patients (74.8%) had experienced some form of efficacious outcome. Ten patients (4.8%) had developed complications such as hematoma, thrombophlebitis, and ulceration. The incidence of complications differed significantly across the categories (P = .030), with more complications reported for those with type I VMs.
We found that intervention with foam sclerotherapy using STS 3% is clinically effective and safe for patients with VMs and was most successful for those with Puig type I and II VMs.
我们评估了静脉畸形（VMs）介入治疗的有效性和安全性，根据我们在单一专科中心的经验，泡沫硬化疗法为首选治疗方法。
通过前瞻性数据库确定2015年1月1日至2019年12月31日期间接受介入治疗（即栓塞硬化疗法和/或开放手术）的所有VMs患者。VM类型根据Puig分类法进行分类。评估的结果指标包括疗效和并发症。前者分为四组：无反应、轻度反应、中度反应和完全反应。并发症定义为任何组织或功能损害、远端栓塞或组织反应。连续变量采用方差分析F检验进行比较，离散变量采用χ检验进行分析。P值<0.05被认为具有统计学意义。
共纳入207例患者。Puig I型病变接受3%十四烷基硫酸钠（STS）泡沫硬化疗法的可能性显著较低（P≤0.001），而接受手术切除的可能性较高（P≤0.001）。在研究期间患者的首次治疗中，所有类型VM的3% STS泡沫体积存在显著差异（P≤0.001）。与II型和III型VM患者相比，I型VM患者接受的3% STS体积较低。所有类型VM的疗效结果类别存在显著差异（P≤0.001）。总体而言，只有14例患者（6.8%）报告疗效无改善，38例患者（18%）未参加随访。因此，154例患者（74.8%）经历了某种形式的有效结果。10例患者（4.8%）出现了血肿、血栓性静脉炎和溃疡等并发症。各类型并发症发生率差异显著（P = 0.030），I型VM患者报告的并发症更多。
我们发现，使用3% STS进行泡沫硬化疗法干预对VM患者临床有效且安全，对Puig I型和II型VM患者最为成功。
