SS21. Foam Sclerotherapy for Low-Flow Vascular Malformations is Safe and Effective in Children

Vascular malformations (VM) are a heterogeneous group of lesions with the potential to cause significant lifelong morbidity in children. Diagnosis and treatment of these lesions may be complex and requires a multidisciplinary approach. Sclerotherapy is widely used as an alternative to surgical resection in adults; however, limited data are available regarding its use in a pediatric setting. The purpose of this study was to evaluate the efficacy and safety of sclerotherapy for pediatric VMs. In this retrospective study, we reviewed our multidisciplinary committee database for all patients less than 18 years of age treated for VM from 2008 to 2017. Of these, patients with low-flow malformations treated with foam sclerotherapy were included. Foam sclerotherapy was performed either with polidocanol or sodium tetradecyl sulfate. Patient characteristics were assessed including demographics, presenting symptoms, and anatomic location of malformation. Outcomes included treatment response, number of procedures, and postprocedural complications. The 61 patients with 61 VMs included 27 boys (44.3%) and 34 girls (55.7%), with mean age of 10.3 ± 5.3 years (Table). The cohort included 32 venous (52.5%), 16 lymphatic (26.2%), and 8 mixed venous/lymphatic (13.1%) malformations, along with 5 associated with Klippel-Trenaunay syndrome (8.2%). Primary indications for intervention included pain and swelling (n = 12 [19.6%]), pain alone (n = 23 [37.7%]), swelling alone (n = 15 [24.6%]), functional impairment (n = 8 [13.1%]), and bleeding (n = 3 [4.9%]). Anatomic distributions varied with 13 head/neck (21.3%), 5 truncal (8.2%), 10 upper extremity (16.4%), 27 lower extremity (44.3%) , and 6 diffuse (9.8%) diffuse. Among the head/neck lesions, 8 (13.1%) extended to the face and of the extremity lesions, 5 (8.2%) extended to the hand, and 17 (27.9%) to the foot. Overall, sclerotherapy resulted in significant improvement or complete resolution of symptoms in 53 patients (86.9%). Complications were observed in 7 patients (11.4%), with 6 cases (9.8%) of superficial skin ulceration that resolved without intervention, and 1 infection (1.6%) requiring antibiotics. No patients experienced adverse hemodynamic consequences or venous thromboembolism. This series of pediatric VMs, the largest of its kind to date, demonstrates that sclerotherapy with foam-based agents effectively reduces symptoms with an acceptable rate of complications. Further study is needed to determine the optimal sclerosing agents for individual subsets of VMs in the pediatric population.TablePatient characteristics and outcomes of foam sclerotherapyCharacteristicAll foam sclerotherapy (n = 61)Polidocanol (n = 35)Sodium tetradecyl sulfate (n = 35)Age, years10.3 (5.3)11.2 (4.6)9.0 (5.7)Male27 (44.3)15 (42.9)15 (42.9)Anatomic location Cephalic/cervical13 (21.3)6 (17.1)8 (22.9) Truncal5 (8.2)2 (5.7)3 (8.6) Upper extremity10 (16.4)6 (17.1)7 (20.0) Lower extremity27 (44.3)18 (51.4)13 (37.1) Diffuse6 (9.8)3 (8.6)4 (11.4)Type of VM Lymphatic16 (26.2)4 (11.4)13 (37.1) Venous32 (52.5)21 (60.0)17 (48.6) Venolymphatic8 (13.1)7 (20.0)3 (8.6) Klippel-Trenaunay syndrome5 (8.2)3 (8.6)2 (5.7)No. of treatments2.85 (3.33)3.65 (4.15)2.49 (2.67) Range1-211-211-13Symptom response Completely resolved15 (24.6)7 (20.0)9 (25.7) Significantly improved38 (62.3)24 (68.6)22 (62.9) No change8 (13.1)4 (11.4)4 (11.4)Complications7 (11.4)4 (11.4)4 (11.4) Specific complicationsUlcerationInfection requiring antibiotics, ulcerationContinuous variables reported as mean (SD), categorical variables reported as n (%). Open table in a new tab