Sclerotherapy

The abnormal vessel complex is destroyed using a local irritant substance (such as alcohol, polidocanol, cyanoacrylate glue, etc.).

The aim of therapy is to destroy the innermost layer of the vessel wall (endothelium) so that the abnormal vessel becomes thrombosed (from the Greek meaning ‘hard’) and is therefore no longer perfused with blood.

Sclerotherapy is mostly used in patients in whom the blood flow in the malformation is slow (low-flow) and the venous outward flow is most prominent. With these malformations, no supplying artery can usually be identified, which means that the destruction is achieved through direct injection into the venous vascular complex.

Beforehand

On the day before the treatment or even at the consultation in our outpatient clinic, we carry out a precise ultrasound examination of the region to evaluate the blood flow ratios and to define the exact treatment strategy. If it has not already been carried out, we also perform an MRI scan, which offers the best possible soft tissue contrast.

During

During sclerotherapy the vascular malformation is pierced directly through the skin from the outside and the sclerosing substance is applied directly into the vein. The piercing procedure is carried out under ultrasound guidance, while the delivery of the sclerosing substances is carried out under X-ray guidance. Due to possible pain and to avoid patient movements during the procedure, it is generally carried out under general anaesthetic.

After

After treatment, the treated malformation should be compressed with a pressure bandage.

Many patients experience temporary pain due to the reduced perfusion and thrombosis of the embolised vascular tree. In the case of superficial malformations, for example, there is reddening and swelling.

Potential more severe complications may include allergic reactions, infection of the area with less blood supply and in very rare cases necrosis of the skin over the malformation. False embolisation may also occur in a non-target vessel.

Embolisation

Embolisation works by closing off the supplying arterial vessels. The arterial perfusion of the vascular malformation is reduced or cut off altogether. Trans-arterial embolisation is primarily used for vascular malformations with a high blood flow (high-flow).

The arterial supply to the malformation is reduced or stopped with embolisate.

Trans-arterial embolisation is primarily used for malformations that are mainly supplied by one or more arteries and which have a fast blood velocity (high-flow malformations) (Figure 2).

Beforehand

On the day before the treatment or even at the consultation in our outpatient clinic, we carry out a precise ultrasound examination of the region to evaluate the blood flow ratios and to define the exact treatment strategy. If it has not already been carried out, we also perform an MRI scan, which offers the best possible soft tissue contrast.

During

Due to the potential for pain, we generally carry out the treatment under general anaesthetic. The embolisate is delivered to the vascular malformation via a small catheter, which we generally introduce via an artery in the groin.

Embolisates include small metal spirals (coils or plugs) which induce thrombosis, high-percentage alcohol, small plastic particles, tissue adhesives (cyanoacrylate glue) or liquid embolisates (ethylene-vinyl alcohol co-polymers) (Figure 4).

After

In complex malformations, the combination of sclerotherapy and trans-arterial embolisation may be useful (Figure 5). Several treatment sessions are usually required to treat the malformation completely. Following successful embolisation and sclerosis, surgical resection may also be considered if the tumour has caused disruptive space-occupying effects.

Many patients experience temporary pain due to the reduced perfusion and thrombosis of the embolised or sclerosed area, and usually also reddening and swelling.

Potential more severe complications may include allergic reactions, infection of the area with less blood supply and in very rare cases necrosis of the skin over the malformation.

Laser coagulation

For superficial vascular malformations close to the skin, a single or cumulative trans-cutaneous laser treatment may be useful. For more information, visit the > website of the Elisabeth-Klinik Berlin’s Laser Centre.

 

Surgical resection

The treatment of vascular malformations follows a multi-disciplinary approach with the involvement of several medical specialities. Following successful embolisation or sclerosis, for example, surgical resection – provide this is anatomically possible – of the remaining and now much less well-perfused tumour section may be useful.

 

Manual compression

Manual compression following embolisation or sclerotherapy, e.g. with a pressure dressing, should ideally be carried out in order to compress the extended vascular complex and to therefore improve the success of the treatment.

 


> More information: What are AVMs?

Contact


Minimally Invasive Tumour Therapy (MITT)
Charité Campus Virchow-Klinikum (CVK)
Department of Radiology
Augustenburger Platz 1
13353 Berlin

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