Capillary-venous malformation and pregnancy: Rationale of ethanol sclerotherapy

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Abstract

Capillary-venous malformation (CVM) during pregnancy may cause severe pain but has received less attention than the frequent critical onset of arteriovenous malformation during pregnancy. We experienced two patients with CVM related to pregnancy. The first patient had aborted her first pregnancy due to severe pain and desired a subsequent pregnancy without complications. The second had wanted to become pregnant after ethanol sclerosing therapy for a huge neck CVM. They were both treated with percutaneous ethanol sclerosing therapy. They soon became pregnant and achieved full-term delivery without any relapse except for transient mild pains at the end of the first trimester. Ethanol sclerotherapy was useful in controlling the CVM related to the pregnancy.

Introduction

Capillary-venous malformation (CVM) is a vascular malformation, which may appear or worsen at any stage of life, including during pregnancy [1], [2]. Percutaneous sclerosing therapies are the most frequently used treatments [3], [4]. In contrast to the frequently documented onset of arteriovenous malformation (AVM) that unexpectedly causes life threatening hemorrhage in pregnant woman [1], [5], [6], little information has is available about the onset and management of CVM during pregnancy.

Section snippets

Method

When findings on physical examination, sonography, and/or MRI study were suggestive of CVM, direct puncture cisternography was carried out with a 22–24 gauge i.v. cannula. At the diagnosis of CVM, percutaneous ethanol injection therapy was performed under local anesthesia, and keeping close communication with the patient. A total ethanol dose of 0.5–0.7 ml/cm2 of the lesion area size was injected in one or multiple sessions. Ethanol was mixed with a water-soluble contrast media (Iopamiron 370 mg 

Case 1

A 26-year-old woman who had aborted her first pregnancy due to painful CVM was referred to our clinic. Several asymptomatic blue spots had been present on her right shoulder since birth. In the third month of the first pregnancy a painful mass appeared in the right shoulder. Soon she became unable to raise her right arm due to the pain, and the pregnancy was terminated at the fifth month because of increasing pain. Eight months after the abortion she still felt mild pain around the persisting

Discussion

Little information is available about the onset and management of CVM before and during pregnancy [1], [7]. AVM can cause hemorrhage or severe pain during pregnancy and the postpartum period [8], with brain [1], [5], [6], [9], lungs [10], [11], salpinx [12], pelvis space [13], uterus [14], [15], kidney [16], [17], limbs [18], [19] and head and neck [5] reportedly being involved. Some patients with AVM had a fatal outcome and others had to experienced pathological or underwent induced abortion

Conclusion

It must be recognized that CVM may endanger the pregnancy as well as AVM. Careful use of ethanol sclerotherapy may be recommended as a safe and effective first choice for treatment of CVM in women who are or may become pregnant.

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