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Dual-agent percutaneous sclerotherapy technique for macrocystic lymphatic malformations
M Travis Caton1, Amanda Baker2, Eric R Smith2
1Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA travis.caton@gmail.com.
Journal of Neurointerventional Surgery
|August 17, 2022
Summary
This video demonstrates a dual-agent sclerotherapy technique for head and neck lymphatic malformations. It uses sodium tetradecyl followed by doxycycline to improve safety and efficacy, minimizing complications.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Dermatology
Background:
- Lymphatic malformations (LMs) of the head and neck are common, often requiring treatment.
- Percutaneous sclerotherapy offers high success rates (over 84%) for treating these lesions.
- Sodium tetradecyl and doxycycline are recognized as safe and effective sclerosants.
Discussion:
- Severe complications from sclerotherapy are rare, but temporary local issues (14%) and skin necrosis (0.8-5.8%) can occur.
- Facial and neck locations of LMs make even minor complications aesthetically significant.
- A dual-agent approach using sodium tetradecyl and doxycycline is presented to mitigate risks.
Key Insights:
- The described technique employs sodium tetradecyl as a 'primer' followed by doxycycline as the definitive sclerosant.
- Meticulous backtable preparation is crucial for this dual-agent approach.
- Ultrasound and fluoroscopy are emphasized for precise needle placement and complication avoidance.
Outlook:
- This technique aims to enhance safety and reduce disfigurement associated with head and neck LM treatment.
- Further evaluation of the dual-agent approach in clinical practice is warranted.
- The video serves as a technical guide for practitioners performing percutaneous sclerotherapy.
