An institution-wide algorithm for direct-stick embolization of peripheral venous malformations

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Dermatology

Background:

• Congenital peripheral venous malformations (VMs) lack standardized treatment algorithms, leading to varied outcomes.
• Current management options and embolic agents for VMs are not uniform.
• This study addresses the need for a consistent approach to managing symptomatic VMs.

Purpose of the Study:

• To present an institution-wide algorithm for managing symptomatic congenital peripheral VMs.
• To evaluate the efficacy and safety of a single embolotherapeutic agent for VM treatment.
• To establish a standardized protocol for VM embolization.

Main Methods:

• A 36-month retrospective review of patients with symptomatic congenital peripheral VMs treated with a specific algorithm.
• Utilized contrast-enhanced MRI, venous duplex ultrasound, and hematologic monitoring.
• Embolization performed using direct-stick technique with two concentrations of sodium tetradecyl sulfate (STS).

Main Results:

• 71 direct-stick embolizations (DSEs) were performed in 40 patients over 36 months.
• 65% of patients experienced complete symptom relief after a single DSE session.
• The primary complications were skin necrosis (3%), with one case of fatal pulmonary embolism (1.4%).

Conclusions:

• Liquid sodium tetradecyl sulfate (STS) is a safe embolotherapeutic agent for congenital peripheral VMs, avoiding ethanol-related toxicity.
• Venous thromboembolism remains a significant risk despite careful monitoring.
• Further prospective randomized trials are necessary to standardize embolotherapeutic approaches for VMs.