Purpose

To evaluate factors that contribute to adverse events (AEs) after embolization of venous malformations (VMs) using sclerosing agents.

Materials and Methods

A retrospective review of patients who underwent direct puncture embolization of VMs with a sclerosing agent and adjunctive techniques, also termed as sclerotherapy, from 2016 to 2021 was performed. Three-hundred one embolizations in 137 patients (median age, 19.0 years; interquartile range, 12.8–31.5 years) were evaluated. The VM characteristics and embolization details were analyzed. Anticoagulation was also evaluated based on D-dimer levels. Cutaneous and noncutaneous AEs were analyzed. The AEs were categorized using Society of Interventional Radiology guidelines.

Results

VMs involving tissue planes were subcutaneous (n = 104), intramuscular (n = 84), and combined (n = 113). Overlying skin involvement was observed in 56% of the patients. Sodium tetradecyl sulfate was mainly used (83%). Periprocedural anticoagulation was used in 9% of the patients. Most AEs were minor (30/301, 9.7%), and only 1.7% (5/301) were major (21 cutaneous and 14 noncutaneous AEs). Age below 18 years (odds ratio, 4.4502; 95% confidence interval, 1.5607–12.6890; P = .0052) and overlying skin involvement (odds ratio, 7.1794; 95% confidence interval, 1.6226–31.7656; P = .0094) were factors associated with cutaneous AEs. All noncutaneous AEs developed in patients with intramuscular VMs; however, this association was not statistically significant. There was no severe hematologic AE or permanent consequence.

Conclusions

The overall AE rate after VM embolization was 11.6%; however, major AEs were rare (1.7%). Cutaneous AEs were associated with young age and overlying skin involvement. All noncutaneous AEs developed in patients with intramuscular VMs.

中文翻译：

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影响静脉畸形硬化治疗后不良事件的因素

目的

评估使用硬化剂栓塞静脉畸形 (VM) 后导致不良事件 (AE) 的因素。

材料和方法

对 2016 年至 2021 年接受硬化剂和辅助技术（也称为硬化疗法）直接穿刺栓塞 VM 的患者进行了回顾性研究。对 137 名患者（中位年龄 19.0 岁；四分位间距 12.8-31.5 岁）的 301 次栓塞进行了评估。分析了 VM 特征和栓塞细节。还根据 D-二聚体水平评估了抗凝作用。分析了皮肤和非皮肤 AE。使用介入放射学会指南对 AE 进行分类。

结果

涉及组织平面的 VM 为皮下 (n = 104)、肌内 (n = 84) 和联合 (n = 113)。在 56% 的患者中观察到覆盖皮肤受累。主要使用十四烷基硫酸钠（83%）。9% 的患者使用了围手术期抗凝治疗。大多数 AE 是轻微的 (30/301, 9.7%)，只有 1.7% (5/301) 是主要的（21 例皮肤 AE 和 14 例非皮肤 AE）。年龄低于 18 岁（比值比，4.4502；95% 置信区间，1.5607–12.6890；P  = .0052）和上覆皮肤受累（比值比，7.1794；95% 置信区间，1.6226–31.7656；P = .0094) 是与皮肤 AE 相关的因素。肌内 VM 患者发生的所有非皮肤 AE；然而，这种关联在统计上并不显着。没有严重的血液学 AE 或永久性后果。

结论

VM栓塞后总体AE率为11.6%；然而，主要 AE 很少见 (1.7%)。皮肤 AE 与年轻和上覆皮肤受累有关。所有非皮肤 AE 均在肌内 VM 患者中发生。