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Complications of sclerotherapy for 75 head and neck venous malformations

  • Head and Neck
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Abstract

Sclerotherapy is one treatment option for head and neck venous malformations (VMs). Evaluation of complication risks is, however, essential to improve its safety. We aimed to systematically report sclerotherapy complications by means of the Clavien-Dindo classification and to distinguish factors predisposing to complications. We identified our institution’s head and neck VM patients who received sclerotherapy between 1 January 2007 and 31 August 2013, analyzed patient reports retrospectively, and applied to them the Clavien-Dindo classification. Our 75 VM patients underwent a total of 150 sclerotherapy sessions. The most common sclerosants were 3 % sodium tetradecyl sulfate and polidocanol. Complications occurred in 13 patients (17.3 %) and in 15 sessions (10.0 %); 3 complications required extensive postprocedural treatment and caused permanent morbidity, whereas 12 received conservative treatment. Patients with sclerotherapy complications underwent more treatments (p = 0.009) and more often needed further surgery (p = 0.007). We thus consider sclerotherapy a relatively safe treatment modality for head and neck VMs. To avoid complications, evaluation of VM characteristics and optimal treatment technique in a multidisciplinary team is vital.

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References

  1. Mulliken JB, Fishman SJ, Burrows PE (2000) Vascular anomalies. Curr Probl Surg 37(8):517–584

    Article  CAS  PubMed  Google Scholar 

  2. Vikkula M, Boon LM, Mulliken JB (2001) Molecular genetics of vascular malformations. Matrix Biol 20(5–6):327–335

    Article  CAS  PubMed  Google Scholar 

  3. Mounayer C, Wassef M, Enjolras O, Boukobza M, Mulliken JB (2001) Facial “glomangiomas”: large facial venous malformations with glomus cells. J Am Acad Dermatol 45(2):239–245

    Article  CAS  PubMed  Google Scholar 

  4. Vikkula M, Boon LM, Carraway KL 3rd et al (1996) Vascular dysmorphogenesis caused by an activating mutation in the receptor tyrosine kinase TIE2. Cell 87(7):1181–1190

    Article  CAS  PubMed  Google Scholar 

  5. Dubois J, Garel L (1999) Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group. Pediatr Radiol 29(12):879–893

    Article  CAS  PubMed  Google Scholar 

  6. Dubois J, Soulez G, Oliva VL, Berthiaume MJ, Lapierre C, Therasse E (2001) Soft-tissue venous malformations in adult patients: imaging and therapeutic issues. Radiographics 21(6):1519–1531

    Article  CAS  PubMed  Google Scholar 

  7. Legiehn GM, Heran MK (2008) Venous malformations: Classification, development, diagnosis, and interventional radiologic management. Radiol Clin North Am 46(3):545–597

  8. Berenguer B, Burrows PE, Zurakowski D, Mulliken JB (1999) Sclerotherapy of craniofacial venous malformations: Complications and results. Plast Reconstr Surg 104(1):1–11 (discussion 12-5)

  9. Boukobza M, Enjolras O, Guichard JP et al (1996) Cerebral developmental venous anomalies associated with head and neck venous malformations. AJNR Am J Neuroradiol 17(5):987–994

    CAS  PubMed  Google Scholar 

  10. Steiner F, FitzJohn T, Tan ST (2013) Surgical treatment for venous malformation. J Plast Reconstr Aesthet Surg 66(12):1741–1749

    Article  PubMed  Google Scholar 

  11. Hein KD, Mulliken JB, Kozakewich HP, Upton J, Burrows PE (2002) Venous malformations of skeletal muscle. Plast Reconstr Surg 110(7):1625–1635

    Article  PubMed  Google Scholar 

  12. Lee BB, Bergan JJ (2002) Advanced management of congenital vascular malformations: a multidisciplinary approach. Cardiovasc Surg 10(6):523–533

    Article  PubMed  Google Scholar 

  13. Buckmiller LM (2004) Update on hemangiomas and vascular malformations. Curr Opin Otolaryngol Head Neck Surg 12(6):476–487

    Article  PubMed  Google Scholar 

  14. Werner JA, Lippert BM, Hoffmann P, Rudert H (1995) Nd: YAG laser therapy of voluminous hemangiomas and vascular malformations. Adv Otorhinolaryngol 49:75–80

    CAS  PubMed  Google Scholar 

  15. Wimmershoff MB, Landthaler M, Hohenleutner U (1999) Percutaneous and combined percutaneous and intralesional nd: YAG-laser therapy for vascular malformations. Acta Derm Venereol 79(1):71–73

    Article  CAS  PubMed  Google Scholar 

  16. Burrows PE (2013) Endovascular treatment of slow-flow vascular malformations. Tech Vasc Interv Radiol 16(1):12–21

    Article  PubMed  Google Scholar 

  17. Lee BB, Do YS, Byun HS, Choo IW, Kim DI, Huh SH (2003) Advanced management of venous malformation with ethanol sclerotherapy: mid-term results. J Vasc Surg 37(3):533–538

    Article  CAS  PubMed  Google Scholar 

  18. Tachibana K, Kobayashi S, Kojima T, Kaseno S, Kemmotsu O (2004) Pulmonary emboli in sclerotherapy for peripheral vascular malformations under general anesthesia; a report of two cases. Masui 53(6):645–649

    PubMed  Google Scholar 

  19. Barranco-Pons R, Burrows PE, Landrigan-Ossar M, Trenor CC 3rd, Alomari AI (2012) Gross hemoglobinuria and oliguria are common transient complications of sclerotherapy for venous malformations: review of 475 procedures. AJR Am J Roentgenol 199(3):691–694

    Article  PubMed  Google Scholar 

  20. Qiu Y, Chen H, Lin X, Hu X, Jin Y, Ma G (2013) Outcomes and complications of sclerotherapy for venous malformations. Vasc Endovascular Surg 47(6):454–461

    Article  PubMed  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  22. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111(5):518–526

    CAS  PubMed  Google Scholar 

  23. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  24. Kollipara R, Dinneen L, Rentas KE et al (2013) Current classification and terminology of pediatric vascular anomalies. AJR Am J Roentgenol 201(5):1124–1135

    Article  PubMed  Google Scholar 

  25. Siniluoto TM, Svendsen PA, Wikholm GM, Fogdestam I, Edstrom S (1997) Percutaneous sclerotherapy of venous malformations of the head and neck using sodium tetradecyl sulphate (sotradecol). Scand J Plast Reconstr Surg Hand Surg 31(2):145–150

    Article  CAS  PubMed  Google Scholar 

  26. Glade RS, Richter GT, James CA, Suen JY, Buckmiller LM (2010) Diagnosis and management of pediatric cervicofacial venous malformations: retrospective review from a vascular anomalies center. Laryngoscope 120(2):229–235

    PubMed  Google Scholar 

  27. Lee IH, Kim KH, Jeon P et al (2009) Ethanol sclerotherapy for the management of craniofacial venous malformations: the interim results. Korean J Radiol 10(3):269–276

    Article  PubMed  PubMed Central  Google Scholar 

  28. Alexander MD, McTaggart RA, Choudhri OA, Marcellus ML, Do HM (2013) Percutaneous sclerotherapy with ethanolamine oleate for venous malformations of the head and neck. J Neurointerv Surg. doi:10.1136/neurintsurg-2013-010924

  29. Stimpson P, Hewitt R, Barnacle A, Roebuck DJ, Hartley B (2012) Sodium tetradecyl sulphate sclerotherapy for treating venous malformations of the oral and pharyngeal regions in children. Int J Pediatr Otorhinolaryngol 76(4):569–573

    Article  PubMed  Google Scholar 

  30. Leung M, Leung L, Fung D et al (2013) Management of the low-flow head and neck vascular malformations in children: The sclerotherapy protocol. Eur J Pediatr Surg. doi:10.1055/s-0033-1354585

  31. Sachin K, Rashmi S, Manish S, Siddhartha W, Uday L (2013) Haemangiomas and venous malformations of the head and neck: a retrospective analysis of endovascular management in 358 patients. Indian J Plast Surg 46(1):109–116

    Article  PubMed  PubMed Central  Google Scholar 

  32. Spence J, Krings T, TerBrugge KG, Agid R (2011) Percutaneous treatment of facial venous malformations: a matched comparison of alcohol and bleomycin sclerotherapy. Head Neck 33(1):125–130

    Article  PubMed  Google Scholar 

  33. Hu X, Chen D, Jiang C et al (2011) Retrospective analysis of facial paralysis caused by ethanol sclerotherapy for facial venous malformation. Head Neck 33(11):1616–1621

    Article  PubMed  Google Scholar 

  34. Su L, Fan X, Zheng L, Zheng J (2010) Absolute ethanol sclerotherapy for venous malformations in the face and neck. J Oral Maxillofac Surg 68(7):1622–1627

    Article  PubMed  Google Scholar 

  35. Wang YA, Zheng JW, Zhu HG, Ye WM, He Y, Zhang ZY (2010) Sclerotherapy of voluminous venous malformation in head and neck with absolute ethanol under digital subtraction angiography guidance. Phlebology 25(3):138–144

    Article  CAS  PubMed  Google Scholar 

  36. Rosbe KW, Hess CP, Dowd CF, Frieden IJ (2010) Masseteric venous malformations: diagnosis, treatment, and outcomes. Otolaryngol Head Neck Surg 143(6):779–783

    Article  PubMed  Google Scholar 

  37. Liu Y, Liu D, Wang Y, Zhang W, Zhao F (2009) Clinical study of sclerotherapy of maxillofacial venous malformation using absolute ethanol and pingyangmycin. J Oral Maxillofac Surg 67(1):98–104

    Article  PubMed  Google Scholar 

  38. Kaji N, Kurita M, Ozaki M et al (2009) Experience of sclerotherapy and embolosclerotherapy using ethanolamine oleate for vascular malformations of the head and neck. Scand J Plast Reconstr Surg Hand Surg 43(3):126–136

    Article  PubMed  Google Scholar 

  39. Zhi K, Wen Y, Li L, Ren W (2008) The role of intralesional pingyangmycin in the treatment of venous malformation of facial and maxillary region. Int J Pediatr Otorhinolaryngol 72(5):593–597

    Article  PubMed  Google Scholar 

  40. Chen WL, Yang ZH, Bai ZB, Wang YY, Huang ZQ, Wang YJ (2008) A pilot study on combination compartmentalisation and sclerotherapy for the treatment of massive venous malformations of the face and neck. J Plast Reconstr Aesthet Surg 61(12):1486–1492

    Article  PubMed  Google Scholar 

  41. Bonan PR, Miranda Lde P, Mendes DC, de Paula AM, Pego SP, Martelli-Junior H (2007) Effectiveness of low flow vascular lesions sclerosis with monoethanolamine: report of six cases. Med Oral Patol Oral Cir Bucal 12(7):E524–E527

    PubMed  Google Scholar 

  42. Kim KH, Sung MW, Roh JL, Han MH (2004) Sclerotherapy for congenital lesions in the head and neck. Otolaryngol Head Neck Surg 131(3):307–316

    Article  PubMed  Google Scholar 

  43. Johnson PL, Eckard DA, Brecheisen MA, Girod DA, Tsue TT (2002) Percutaneous ethanol sclerotherapy of venous malformations of the tongue. AJNR Am J Neuroradiol 23(5):779–782

    PubMed  Google Scholar 

  44. Chen G, Cai X, Ren JG, Jia J, Zhao YF (2013) Unexpected development of tongue squamous cell carcinoma after sclerotherapy for the venous malformation: a unique case report and literature review. Diagn Pathol 8(1):182

    Article  PubMed  PubMed Central  Google Scholar 

  45. Omary RA, Bettmann MA, Cardella JF et al (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14(9 Pt 2):S293–S295

    Article  PubMed  Google Scholar 

  46. Shireman PK, McCarthy WJ, Yao JS, Vogelzang RL (1997) Treatment of venous malformations by direct injection with ethanol. J Vasc Surg 26(5):838–844

    Article  CAS  PubMed  Google Scholar 

  47. Kok K, McCafferty I, Monaghan A, Nishikawa H (2012) Percutaneous sclerotherapy of vascular malformations in children using sodium tetradecyl sulphate: the birmingham experience. J Plast Reconstr Aesthet Surg 65(11):1451–1460

    Article  PubMed  Google Scholar 

  48. Schumacher M, Dupuy P, Bartoli J et al (2011) Treatment of venous malformations: first experience with a new sclerosing agent: a multicenter study. Eur J Radiol 80(3):e366–e372

    Article  PubMed  Google Scholar 

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Acknowledgments

We kindly acknowledge the members of our MDT for their comments regarding this paper. We also thank our statistician Timo Pessi for his help with objective statistical analysis and our language editor Carol Norris for her critical reading. We thank Helsinki University Central Hospital and the Finnish Otorhinolaryngological Society for their support to this study. Financial support and funding: Helsinki University Central Hospital, The Finnish Otorhinolarynological Society.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, 00029 HUCH, Helsinki, Finland

    Eeva Castrén, Tuomas Klockars & Anne Pitkäranta

  2. Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    Johanna Aronniemi, Johanna Pekkola & Kimmo Lappalainen

  3. Department of Plastic Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    Pia Vuola

  4. Department of Pediatric Surgery, Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    Päivi Salminen

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  1. Eeva Castrén
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Correspondence to Eeva Castrén.

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Castrén, E., Aronniemi, J., Klockars, T. et al. Complications of sclerotherapy for 75 head and neck venous malformations. Eur Arch Otorhinolaryngol 273, 1027–1036 (2016). https://doi.org/10.1007/s00405-015-3577-x

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  • DOI: https://doi.org/10.1007/s00405-015-3577-x

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