PDF herunterladen
Semin intervent Radiol 2024; 41(04): 370-375
DOI: 10.1055/s-0044-1791278
Review Article

Primer on Embolic Agents and Sclerosants for the Treatment of Vascular Malformations

Junaid Raja
1   Division of Vascular and Interventional Radiology, Department of Radiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Dakota Williams
2   Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Rachel Oser
1   Division of Vascular and Interventional Radiology, Department of Radiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Vascular malformations (VMs) are a heterogeneous group of arterial, venous, capillary, and/or lymphatic networks that typically are present at birth and grow with the patient. Signs and symptoms associated with VM range from absent to severe, with a broad spectrum of pain, cosmetic disfigurement, and local tissue destruction. Treatment options for these malformations extend from observation to surgical reconstruction. Each treatment modality has a role in the management of vascular anomalies, but also has specific challenges. Observation is not always sufficient, medical therapies may only be available for a subset of patients and are ultimately not curative, and surgical excision may itself be disfiguring or incomplete/not definitive. Sclerotherapy and/or embolotherapy have become a cornerstone of treatment for many types of VMs. These techniques are applicable to a wide range of VMs, are less invasive, have a shorter recovery period, and are repeatable. Although some VMs may not be amenable to percutaneous or endovascular treatment given their location, and multiple sessions may be required for select large and complex VMs, these minimally invasive treatments are often first line and may be definitive in treating VMs. Various agents may be used in sclerotherapy and embolotherapy, each with their own risks and benefits. Although there is a paucity of Level 1 evidence supporting the superiority of one agent over another, longstanding case series and expert experience exist, informing our knowledge of the safety and efficacy of sclerotherapy and embolotherapy. A brief overview of the most used sclerotherapy and embolotherapy agents and their uses is provided.

Keywords

sclerotherapy - embolotherapy - vascular malformations - vascular anomalies - interventional radiology


Publikationsverlauf

Artikel online veröffentlicht:
07. November 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Dasgupta R, Fishman SJ. ISSVA classification. Semin Pediatr Surg 2014; 23 (04) 158-161
    CrossrefPubMedSuche in Google Scholar
  • 2 Kohout MP, Hansen M, Pribaz JJ, Mulliken JB. Arteriovenous malformations of the head and neck: natural history and management. Plast Reconstr Surg 1998; 102 (03) 643-654
    CrossrefPubMedSuche in Google Scholar
  • 3 Acord M, Srinivasan AS, Cahill AM. Percutaneous treatment of lymphatic malformations. Tech Vasc Interv Radiol 2016; 19 (04) 305-311
    CrossrefPubMedSuche in Google Scholar
  • 4 Osuga K, Yamamoto K, Higashihara H. et al. Endovascular and percutaneous embolotherapy for the body and extremity arteriovenous malformations. Interv Radiol (Higashimatsuyama) 2023; 8 (02) 36-48
    PubMedSuche in Google Scholar
  • 5 Chewning RH, Monroe EJ, Lindberg A. et al. Combined glue embolization and excision for the treatment of venous malformations. CVIR Endovasc 2018; 1 (01) 22
    CrossrefPubMedSuche in Google Scholar
  • 6 Rosen RJ, Contractor S. The use of cyanoacrylate adhesives in the management of congenital vascular malformations. Semin Intervent Radiol 2004; 21 (01) 59-66
    Thieme ConnectPubMedSuche in Google Scholar
  • 7 Uller W, El-Sobky S, Alomari AI. et al. Preoperative embolization of venous malformations using n-butyl cyanoacrylate. Vasc Endovascular Surg 2018; 52 (04) 269-274
    CrossrefPubMedSuche in Google Scholar
  • 8 Takeuchi Y, Morishita H, Sato Y. et al; Committee of Practice Guidelines of the Japanese Society of Interventional Radiology. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol 2014; 32 (08) 500-517
    CrossrefPubMedSuche in Google Scholar
  • 9 Eysenbach LM, Koo KSH, Monroe EJ, Reis J, Perkins JA, Shivaram GM. Migration of n-BCA glue as a complication of venous malformation treatment in children. Radiol Case Rep 2021; 16 (11) 3526-3533
    CrossrefPubMedSuche in Google Scholar
  • 10 De Beule T, Vranckx J, Verhamme P. et al. Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes. Vasa 2016; 45 (06) 497-504
    CrossrefPubMedSuche in Google Scholar
  • 11 Giurazza F, Corvino F, Cangiano G. et al. Transarterial embolization of peripheral high-flow arteriovenous malformation with ethylene vinyl alcohol copolymer (Onyx®): single-center 10-year experience. Radiol Med 2019; 124 (02) 154-162
    CrossrefPubMedSuche in Google Scholar
  • 12 Wohlgemuth WA, Müller-Wille R, Teusch VI. et al. The retrograde transvenous push-through method: a novel treatment of peripheral arteriovenous malformations with dominant venous outflow. Cardiovasc Intervent Radiol 2015; 38 (03) 623-631
    CrossrefPubMedSuche in Google Scholar
  • 13 Duffy DM. Sclerotherapy. Clin Dermatol 1992; 10 (03) 373-380
    CrossrefPubMedSuche in Google Scholar
  • 14 Furie B, Furie BC. Mechanisms of thrombus formation. N Engl J Med 2008; 359 (09) 938-949
    CrossrefPubMedSuche in Google Scholar
  • 15 Green D. Mechanism of action of sclerotherapy. Semin Dermatol 1993; 12 (02) 88-97
    PubMedSuche in Google Scholar
  • 16 Wang CY, Hu J, Sheth RA, Oklu R. Emerging embolic agents in endovascular embolization: an overview. Prog Biomed Eng (Bristol) 2020; 2 (01) 012003
    CrossrefPubMedSuche in Google Scholar
  • 17 Steiner F, FitzJohn T, Tan ST. Ethanol sclerotherapy for venous malformation. ANZ J Surg 2016; 86 (10) 790-795
    CrossrefPubMedSuche in Google Scholar
  • 18 Burrows PE. Endovascular treatment of slow-flow vascular malformations. Tech Vasc Interv Radiol 2013; 16 (01) 12-21
    CrossrefPubMedSuche in Google Scholar
  • 19 Odeyinde SO, Kangesu L, Badran M. Sclerotherapy for vascular malformations: complications and a review of techniques to avoid them. J Plast Reconstr Aesthet Surg 2013; 66 (02) 215-223
    CrossrefPubMedSuche in Google Scholar
  • 20 Qiu Y, Chen H, Lin X, Hu X, Jin Y, Ma G. Outcomes and complications of sclerotherapy for venous malformations. Vasc Endovascular Surg 2013; 47 (06) 454-461
    CrossrefPubMedSuche in Google Scholar
  • 21 Horbach SER, Rigter IM, Smitt JHS, Reekers JA, Spuls PI, van der Horst CMAM. Intralesional bleomycin injections for vascular malformations: a systematic review and meta-analysis. Plast Reconstr Surg 2016; 137 (01) 244-256
    CrossrefPubMedSuche in Google Scholar
  • 22 Sun J, Wang C, Li J, Song D, Guo L. The efficacy of bleomycin sclerotherapy in the treatment of lymphatic malformations: a review and meta-analysis. Braz J Otorhinolaryngol 2023; 89 (04) 101285
    CrossrefPubMedSuche in Google Scholar
  • 23 Mack JM, Peterson EC, Crary SE. et al. Pharmacokinetics of bleomycin sclerotherapy in patients with vascular malformations. Pediatr Blood Cancer 2022; 69 (08) e29733
    CrossrefPubMedSuche in Google Scholar
  • 24 Cheng J. Doxycycline sclerotherapy in children with head and neck lymphatic malformations. J Pediatr Surg 2015; 50 (12) 2143-2146
    CrossrefPubMedSuche in Google Scholar
  • 25 Maleux O, Vander Poorten V, Hermans R, Hens G, Maleux G. Doxycycline sclerotherapy of head and neck lymphatic malformations: intermediate report of 27 cases. Cardiovasc Intervent Radiol 2023; 46 (02) 194-201
    CrossrefPubMedSuche in Google Scholar
  • 26 Bouwman FCM, Verhoeven BH, Klein WM, Schultze Kool LJ, de Blaauw I. Congenital vascular malformations in children: from historical perspective to a multidisciplinary approach in the modern era - a comprehensive review. Children (Basel) 2024; 11 (05) 567
    PubMedSuche in Google Scholar