1. Foam sclerotherapy in treatment of venous malformations
Michał Kowalczyk
Tutor: Assoc. Prof. Przemysław Przewratil MD, PhD
Foam sclerotherapy in treatment of venous malformations
in children.
Department of Pediatric Surgery and Oncology Laboratory for Vascular Anomalies Medical University of Lodz

2. Venous malformation (VM)
ISSVA Classification
International Society for the Study of Vascular Anomalies
V A S C U L A R A N O M A L I E S
TUMORS
MALFORMATIONS
Infantile haemangioma
Low-flow
Fast-Flow
Venous malformation (VM)
Arterial malformation (AM)
Capillary malformation (CM)
Arteriovenous fistula (AVF)
Lymphatic malformation (LM)
Arteriovenous malformation (AVM)

3. Venous malformation lesion composed of abnormal collections of veins
mostly localized in the skin
can affect any other tissue or organ
cutaneous and subcutaneous tissue
muscles
joints
intestines
most frequent low-flow vascular malformations
may cause cosmetic or functional defects as well as
physical disability

4. Venous
malformations

5. Dubois and Puig Classification
Orthop Clin N Am 2006, 37,

6. Foam sclerotherapy
A percutaneous injection of a sclerosing substance directly into a lesion.
Prior to injection the sclerosing agent is mixed with air to make a foam.
Sclerosant agent causes obliteration
of the vessel, what effects in sealing off the blood flow.
It may be administered as an only procedure or in combination with surgical resection.
Multiple sessions are often required to achieve visual improvement or permanent results.

7. Aim of a study
Analysis of the results of the treatment of venous malformations using foam sclerotherapy.

8. Material & Methods Retrospective analysis Foam sclerotherapy
34 patients treated between June 2006 and December 2011
20 female (59%), 14 male (41%)
Age range: 1-15 (average 7 years)
Foam sclerotherapy
Polidocanol (Aethoxysclerol) 1% / 3% | 1 – 6ml
Assessment by US, MRI
Phlebography
Performed prior to the sclerotherapy in 19 patients (56%)
Surgical resection
Preceded by sclerotherapy - 6 patients (18%)
Duration of hospital stay – ranged from 1 to 5 days (average 2,5)

9. VM Localization

10. Demonstrative pictures
4 years old boy
VM of right hand

11. MRI

12. Phlebography
Approach to the VM

13. BEFORE
AFTER

14. BEFORE
AFTER

15. Foam sclerotherapy

16. Indications Function impairment Distortion of anatomical landmarks
Thrombosis
Pain
Cosmetic

17. Results Outcome Lesion regression 4 grade scale of clinical assessment
Very good
80-100%
Good
60-80%
Moderate
20-50%
Without improvement
<20%

18. Results
26% % 15% %

19. Results Temporary side effects were observed in 2 (6%) patients.
Vasculitis – 1 case
Skin necrosis – 1 case
Initial phlebography increased significantly the effectiveness and safety of each sclerotherapy.
In 6 patients (18%) sclerotherapy preceded the surgical resection improving their performance.
Adopted method was rated by parents and patients as effective and hardly invasive.

20. Conclusions
VMs treatment is based on a proper diagnosis according to ISSVA classification, differentiating them from infantile hemangiomas.
Sclerotherapy with polidaconol used as foam is effective and safe managment of VMs.

21. Thank you Any Questions? for your attention.