Objective
To evaluate the efficacy and safety of gelified ethanol, a newly developed sclerosing agent for slow-flow vascular malformations.

Radio-opaque ethylcellulose-ethanol is a safe and efficient sclerosing agent for venous malformations

Absolute ethanol is the most effective agent in the treatment of venous malformation (VM) although it is quite risky to use because of the danger of diffusion beyond the target. To reduce this risk, we have developed an alcoholic sclerosing solution that is less diffusible.

The viscosity of absolute ethanol was enhanced with monographic ethyl-cellulose at a concentration of 5.88% ie 0.75 g in 15 ml of absolute ethanol 95%. 23 patients with VM located on the buttock (1), hand (2), leg (1) and face (19) were treated. A mean volume of 1.99 ml of the solution was injected directly into the VM. Each patient had an average of 2.8 procedures. Sixteen patients were done under general anaesthesia and seven with local anaesthesia.

Evaluation was performed by the patient, the dermatologist of the treating multidisciplinary team and a dermatological group not involved in the treatment of the patients. Patients were evaluated after a mean delay of 24.52 months. Evaluation of the cosmetic result was made with a five point scale and the global result with a three point scale. VM pain was evaluated by the patients with a Visual Analogue Scale.

The aesthetic results were graded as satisfactory (> 3) for the patient and the dermatologist of the multidisciplinary team. However the results were not as good with the independent dermatological group evaluation. The pain was significantly less important after the treatment (p << 0.001). Among the 23 patients, the local adverse events were nine necrosis with or without ethylcellulose fistula followed by only two surgical procedures. There were no systemic adverse events. Sclerotherapy of VM is usually performed with absolute ethanol or ethibloc. The main advantage of our sclerosing mixture is that it expands like a balloon when injected slowly in a aqueous media. Because of the important increase in viscosity the volume of injected solution is much lower than ethanol alone and the risk of systemic reactions is lower. Contrary to ethibloc, post-sclerosing surgery is not necessary because sub-cutaneous ethylcellulose disappears secondarily.

/pdf/a-new-sclerosing-agent-in-the-treatment-of-venous-2ra3sea7dn.pdf

A new sclerosing agent in the treatment of venous malformations. Study on 23 cases.

https://hal.archives-ouvertes.fr/hal-00820364/document

Treatment of venous malformations: First experience with a new sclerosing agent – A multicenter study

Background Sclerotherapy is often the primary treatment for peripheral venous malformations. It is mostly sufficient alone, but can be combined with other endovascular techniques. Despite its mini-invasiveness, it is not without potentially severe complications. Here, we systematically report sclerotherapy complications in trunk and extremity venous malformations. Methods We retrospectively assessed the complications of 127 consecutive patients who had received sclerotherapy for peripheral venous malformation in our tertiary care unit (January 2007-August 2013). We applied the Clavien-Dindo classification to grade the severity of complications. We mostly used detergent sclerosants (85.7%), and less often ethanol (5.7%) or bleomycin (4.2%). In 4.2% of the procedures, we combined glue, coils, endovascular laser or particles to sclerotherapy. Results The overall complication rate per procedure was 12.5%. Most complications (83.3%) were local and managed conservatively. We encountered four severe complications, all related to blood coagulopathy. Subcutaneous lesion location and use of ethanol significantly increased the risk of local complications. Conclusion Sclerotherapy alone or combined with other endovascular techniques is a safe method for local venous malformations with moderate risk for conservatively manageable complications. Blood coagulopathy constitutes a risk for, otherwise rare, severe complications.

/pdf/sclerotherapy-complications-of-peripheral-venous-4la08h0erb.pdf

Sclerotherapy complications of peripheral venous malformations.

D-dimer level correlation with treatment response in children with venous malformations.

Resume Une embolie pulmonaire est survenue au decours d’une sclerotherapie percutanee (0,5 mL·kg–1 d’ethanol absolu), realisee sous anesthesie generale chez un enfant de 13 ans, presentant un angiome veineux congenital. L’embolie pulmonaire, suspectee sur le contexte et la symptomatologie, etait confirmee par la scintigraphie pulmonaire, qui montrait trois defects sous-segmentaires droits. L’evolution clinique etait rapidement favorable sous heparine, et la scintigraphie pulmonaire du septieme jour etait normale. Le role de l’ethanol absolu, pour expliquer le contraste entre la severite de la symptomatologie initiale et l’aspect scintigraphique qui montrait une obstruction minime est discute. Les aspects therapeutiques preventifs et curatifs de cette complication severe sont egalement discutes.

Embolie pulmonaire au cours de la sclérothérapie percutanée d’un angiome veineux sous anesthésie générale chez un enfant

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Embolie pulmonaire au cours de la sclérothérapie percutanée d’un angiome veineux sous anesthésie générale chez un enfant