Percutaneous treatment of peripheral vascular malformations with a mixture of polidocanol and CO2. Initial experience

Objective. The percutaneous treatment of peripheral vascular malformations is currently the first treatment option for these processes. We describe our initial experience using a mixture of polidocanol and CO2 as an embolizing agent; we analyze the efficacy and complications of the treatment. Material and methods. Between April 2005 and December 2006, we treated a total of 18 patients, comprising 11 women (61%) and 7 men (39%), with ages ranging from 11 to 80 years. One (5%) vascular malformation was hemodynamically active and the remaining 17 (95%) were hemodynamically inactive. We performed a total of 56 embolizations (mean per patient, 3; range, 1-7) using a mixture of polidocanol and CO2 (mean, 8 cm(3); range, 1-28 cm(3)). The malformations were studied with Doppler ultrasonography, magnetic resonance imaging, and direct puncture angiography and/or arteriography. Specific approaches and treatments were used in each case in function of the location, size, and characteristics of the malformation. Results. Technical success, defined as the possibility of embolizing the malformation, was achieved in all cases. No technical complications occurred. The mean follow-up period was 9 months (range, 1-20). All patients, except one woman who refused to continue treatment, improved objectively and subjectively, and all were able to return to normal daily activities. After embolization, all patients presented edema, pain, and increased functional incapacity that ceased with medical treatment. Conclusion. Percutaneous embolization of vascular malformations using a mixture of polidocanol and CO2 is efficacious and has a low rate of complications. Our initial results are promising but larger studies are necessary to reach definitive conclusions.