Outcome evaluation for the treatment of low flow venous and lymphatic malformations

To propose a standardized method of subjectively and objectively evaluating outcomes of sclerotherapy in treating low flow vascular malformations.

Sixty-six patients with low flow vascular malformations (venous, lymphatic, or combined) were treated with percutaneous sclerotherapy using bleomycin, doxycycline, or sodium tetradecyl sulphate. Each lesion required between 2-5 sessions of sclerotherapy with 8-week intervals in between. The success of sclerotherapy was evaluated subjectively and objectively. The subjective response was based on the degree of patient satisfaction, by recording improvement of their symptoms and quality of life. The objective response was based on the changes in lesion characteristics after treatment, by recording changes in size, sonographic features, number of cystic spaces, and development of phleboliths.

91% of our patients were satisfied with the treatment and reported improvement of symptoms and quality of life. Radiologically, 62% (41/66) of the patients had a reduction in lesion size, 77% (51/66) had a change in echogenicity, 84% (51/61) had a reduction in cystic spaces, and 68% (30/44) developed phleboliths. Of the patients reporting significant improvement, 94% displayed reduction in cystic spaces, 89% displayed change in the echogenicity and 71% showed changes in the size of the lesions, representing a linear correlation.

Evaluating the outcomes of percutaneous sclerotherapy for treating vascular malformations is a recognized challenge. Creating a questionnaire with defined parameters to apply before and after treatment allows objective measurement of outcomes. This will enable improved treatment pathways and treatment choice for patients, informed consent, and enable outcome comparison with other centers.