Percutaneous Sclerotherapy of Venous Malformations of the Hand: A Multicenter Analysis

Abstract

Purpose: To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand.

Materials and methods: A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig's classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments.

Results: The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig's classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients.

Conclusion: Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients.

Level of evidence: Level 4, Retrospective study.

Keywords: Hand; Interventional radiology; Sclerotherapy; Upper extremity; Venous malformation.

Fig. 1 A

29-year-old female patient with extensive findings of VMs in form of multifocal lesions affecting the left upper extremity. a Coronar T1-weighted fat-saturated fast spin-echo MR image demonstrates three separated hyperintense masses of tubular structures (arrows) extending into the flexor muscles of forearm and humerus and the latissimus dorsi muscle. b-d Time-resolved 3D MR angiography and T1-weighted fat-saturated contrast-enhanced MR images show the inferior venous malformation with extension from the middle of the forearm up to the metacarpalia. e T1-weighted fat-saturated contrast-enhanced MR image reveals involvement of the fifth finger (arrow). f + g Negative roadmap images demonstrate drainage of a lesion (arrow) in normal veins corresponding to type II (Puig’s classification) and filling of another lesion within the wrist and the hypothenar region of the right hand (arrow) without venous drainage

Fig. 2

T1-weighted fast spin-echo fat-saturated MR images showing the hyperintense VM of a 23-year-old male patient at intervals between several sclerotherapy sessions. a-c Coronar and axial MR images demonstrate hyperintense tubular structures involving thenar and interdigital region of the left hand extending out to the dermis (arrows). d-f 4 months after treatment initiation: coronar and axial MR images reveal lesion size reduction (arrows) when compared to (a-c). g-i 9 months after treatment initiation: coronar and axial MR images show further lesion size reduction up to 50% (arrows) when compared to (a-c) and (d-f)