Purpose

To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand.

Materials and Methods

A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig’s classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments.

Results

The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig’s classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients.

Conclusion

Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients.

Level of Evidence

Level 4, Retrospective study.

中文翻译：

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手部静脉畸形的经皮硬化疗法：多中心分析

目的

评估经皮硬化剂治疗手部静脉畸形（VMs）的安全性和结果。

材料和方法

对 29 名主要影响手部（包括腕部、腕部和/或手指）的 VM 患者进行了一项回顾性多中心试验，这些患者接受了 81 次使用乙醇凝胶和/或聚多卡醇的经皮图像引导硬化疗法治疗。评估临床和影像学发现以评估临床反应、病变大小减少和并发症发生率。对 Puig 的分类、硬化剂、硬化剂的注射量和先前进行的治疗进行了分层分析。

结果

每名患者的平均手术次数为 2.8 (± 2.2)。最后一次随访（平均 = 9.2 个月）显示 78.9% (15/19) 的症状部分缓解，而 3 名患者 (15.8%) 没有症状，1 名患者 (5.3%) 没有改善。治疗后成像显示总体客观反应率为 88.9%。早期的术后并发症发生在 5/81 (6.2%) 的硬化治疗后，通过保守方法完全解决。VM 类型（Puig 分类）以及硬化剂对临床反应（p  = 0.85，p  = 0.11）或并发症发生率（p  = 0.66，p  = 0.69）没有影响。并发症发生率与注射的硬化剂体积无关（p = 0.76）。此外， 在将有既往治疗史的患者与未接受治疗的患者进行比较时，未检测到临床成功 ( p  = 0.11) 或并发症发生率 ( p = 0.89) 的显着差异。

结论

经皮硬化疗法对治疗手部 VM 既安全又有效。即使有既往治疗史的患者也能从进一步的硬化治疗中获益，显示出与未接受治疗的患者相似的低并发症发生率。

证据水平

第 4 级，回顾性研究。