Experience of the combined application of sclerotherapy and endovascular embolization in the treatment of venous and arteriovenous malformations of surface location
Authors: Altman I.V. 
Published: July 2024

Objective ‒ to evaluate the results of treatment of patients with extra-trunk (diffuse) venous malformations (VM) and microfistulous arteriovenous malformations (AVM) of superficial localization, to whom the technique of sclerotherapy was applied, by direct puncture of the «node» of the malformation and a combination of endovascular embolization with sclerotherapy. Determine the criteria for using the sclerosation method as monotherapy or in combination with embolization.Materials and methods. In the period from 2017 to 2023, 47 patients (22 (46.8 %) men and 25 (53.2 %) women) with VM (n=27) and AVM (n=20) located superficially were examined and treated were treated for the malformation using sclerosation. The age of the patients ranged from 5 to 67 years, the average age ‒ (28.9 ± 7.4) years. Pathology localization: head and neck – 31, upper extremity – 6, lower extremity – 7, trunk – 3. In 17 patients, sclerotherapy was used as monotherapy, 30 patients underwent a combination of sclerotherapy with embolization The observation period ranged from 6 months to 8 years, the average observation period was (5.2 ± 0.98) years.Results. Out of 27 patients with VM, 17 (62.9 %) patients were diagnosed with a VM based on the results of diagnostic venography and arteriography. From 17 patients were treated with sclerotherapy as monotherapy with a satisfactory clinical result in 14 (82.3 %) patients. In 10 (37.1 %) 27 patients with VM, signs of arteriovenous shunt (AVS) were found in the structure of VM. A combination of endovascular embolization and sclerosation was used in the treatment of VM with signs of arteriovenous shunting in 10 patients. A positive effect was obtained in 7 (70.0 %) cases. AVM treatment using a combination of sclerosation and embolization was carried out in 20 patients. A satisfactory clinical result was obtained in 17 (85.0 %) patients. Treatment of 47 patients with VM and AVM was technically successful in all cases (100 %). Overall clinical improvement was obtained in 38 (81.0 %). A complication in the form of tissue necrosis in the malformation area occurred in 3 (6.4 %) patients. 43 (91.4 %) patients received 2 to 4 AVM embolization and 2 to 5 sclerotherapy sessions during the treatment period.Conclusions. According to the obtained results, sclerotherapy by direct puncture of the venous structures of malformations with the introduction of a sclerosing drug into the «node» is a safe and effective method of treating VM. In every third patient (37.1 %) with VM, signs of AVS were found in the structure of VM, which requires prior embolization of existing AVS. Preliminary embolization of the afferent arteries of AVM leads to a slowing down of the blood flow rate and enables the use of sclerotherapy techniques, maintaining the effective concentration of the drug in the «node» of the AVM. Evaluation of the results of the treatment of 47 patients with extra-trunk (diffuse) venous and microfistulous AVM of superficial localization using the methods of endovascular embolization and sclerotherapy proves that the combined use of these methods allows to improve the results and increase the effectiveness of the treatment of this complex pathology.