Pediatric Sclerotherapy Treatments for Vascular Malformations
Vascular malformations include abnormal connections between arteries and veins (AVM), hemangiomas, venous malformations and lymphatic malformations (lymphangiomas).
AVMs and hemangiomas are referred to as “high-flow” because of the rapid flow of blood in the arteries and veins. AVMs are less common than hemangiomas and are treated by occluding the feeding artery from inside the artery; e.g. arterial embolization. Arterial embolization is usually reserved for patients with large hemangiomas that are life threatening.
Hemangiomas usually shrink in early childhood but may need medical treatment such as propranolol, a medication that can assist with shrinking the malformation by decreasing blood flow to the area and the ability to form new blood vessels in the malformation.
Venous malformations and lymphatic malformations are referred to as “slow-flow.” In fact, lymphatic malformations have no flow and are composed of cysts of varying size that contain fluid.
Non-surgical treatment of slow-flow vascular malformations
Venous and lymphatic malformations are abnormal collections of veins and lymphatic cysts. They may be visible at birth or become visible as your child gets older. Venous malformations may not be apparent until later in childhood and often increase in size during or close to puberty. These are benign lesions that have no potential to spread to other parts of the body. Indications for treatment are:
- Cosmetic concerns
- Functional impairment
These lesions historically have been treated with surgical removal but we have found that surgery alone often does not remove the entire lesion, may result in significant scarring and may put nerves and muscles at risk.
The preferred treatment is sclerotherapy with surgery following, if needed, to correct cosmetic problems. Our team of Interventional Radiologists partner closely with the plastic surgery team to provide a comprehensive and individualized approach to each child’s care and treatment plan.
Sclerotherapy is the injection of agents through the skin into the abnormal veins or cysts in order to deliver high local concentrations of medication designed to cause the veins or cysts to shrink. These agents include doxycycline, an antibiotic, foam (STS), and absolute alcohol. Lasers can also be used to ablate veins.
These procedures are done by radiologists using ultrasound and fluoroscopy to localize the veins and cysts to deliver the sclerosing agents or medications. Sclerotherapy procedures should be performed by Interventional Radiologists that have extensive experience and expertise with treatment of vascular malformations in the pediatric population as they present with much more complex vascular lesions and have different needs and implications than adults.
What to Expect
Prior to sclerotherapy, your child should have a high-quality MRI that will be used to guide therapy and avoid injury to normal arteries, nerves, muscle, and veins near the malformation. You and your child will meet with the radiologist prior to the procedure being scheduled to discuss benefits and risks of the sclerotherapy and review the MR findings.
Sclerotherapy is performed under anesthesia. The procedure is done as an out-patient; children typically go home the same day after the procedure. If an extremity is treated, your child will have an ACE wrap or compression bandage on for about two weeks that can be removed to bathe. We will want to follow up with your child around two weeks after the sclerotherapy.
The treated area is usually swollen for one to two weeks, with the most swelling being observed one week after the treatment. We may limit your child’s physical activities for two weeks after the procedure. Large venous or lymphatic malformations usually require more than one sclerotherapy repeated at four-to-six week intervals.