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Sclerotherapy is a treatment that has been effective in treating venous malformations and lymphatic malformations. The treatment consists of a percutaneous (through skin) injection of a substance into the abnormal veins of the venous malformation. The substance can be one of many that are able to irritate the wall of the vessel which results in the formation of a blot clot within the vessel. The blood clot will effectively stop the flow of blood through the blood vessel and if the irritation is severe enough, the blood vessel will be destroyed and replaced with scar tissue. These procedures are usually performed in an angiography suite, with the assistance of ultrasound guidance and ‘fluoroscopy’ or real-time x-ray monitoring. If sclerotherapy is the only treatment, several treatments may be necessary to accomplish this. The choice of sclerosant (substance used in the injection), will depend on the flow rate, the location of the lesion and the experience of the interventional radiologist. The more irritating the sclerosant, the more effective the treatment. Unfortunately, this is also accompanied by more potential side effects. The interventional radiologist must therefore weigh the cost benefit ratio when selecting the most appropriate sclerosant. Sometimes, sclerotherapy is performed as a prelude to surgery. The function of sclerotherapy in this scenario is to control and/or prevent bleeding during the surgery. We have found that the advantages of this combined form of treatment are extremely significant. The intraoperative blood loss is reduced significantly and the ease of surgery is greatly facilitated especially when important and vital structures are contained within the venous malformation.
The process whereby an irritant is injected into the substance of a venous malformation thereby clotting off the lesion and partially or completely destroying it is known as percutaneous sclerotherapy. The techniques have evolved and nowadays, in the right hands, this is a safe treatment. Naturally, there are risks and these should be discussed by the interventional radiologist. Percutaneous sclerotherapy is usually repeated several times in order to achieve a desired result. Immediately after treatment, the treatment site swells tremendously. This may last several weeks before gradually subsiding.
Vascular Birthmark Institute
At Manhattan Eye, Ear, and Throat Hospital
210 East 64th Street, 7th Floor New York City, NY 10065