Ethanol threshold doses for systemic complications during sclerotherapy of superficial venous malformations: a retrospective study

Introduction Ethanol has been used for many years for superficial venous malformations (VM) sclerotherapy. Although ethanol is well-tolerated in most of the cases, systemic side effects have been reported in some patients, including cardiac collapse and death. Systemic toxic side effects have been suspected to be proportional to the ratio of ethanol dose divided by the patient's body weight (dose/weight ratio in millilitre per kilogram). No extensive study has yet been conducted to determine the toxic threshold, and no consensus exists on this point. Methods We retrospectively studied the systemic effects of ethanol sclerotherapy in a consecutive series of 71 patients with VM. Results Seventy-one consecutive patients with VMs were treated by ethanol sclerotherapy and 162 procedures were performed. The only factor significantly associated with a systemic adverse event was the ethanol dose/weight ratio per intervention. The ethanol dose/weight ratio superior to 0.24 ml/kg was predictive of systemic toxic effects, suggesting a limit dose for ethanol sclerotherapy of VM. Systematic complications were not related to repetitive sclerotherapy sessions. Conclusion Based on our findings, a maximal ethanol dose/weight ratio of 0.2 ml/kg could be considered as acceptable in VM treatment indications.