Percutaneous Sclerotherapy for Low-flow Vascular Malformations in Paediatric Patients: 6-Year Experience of a Multidisciplinary Team

Objectives: The Vascular Anomalies Multidisciplinary Team at the Queen Elizabeth Hospital, Hong Kong, delivers one-stop integrated care by a comprehensive team of specialists and nurses to paediatric patients with vascular anomalies. This study aimed to review the efficacy, safety, and outcomes of percutaneous sclerotherapy performed at our centre for low-flow vascular malformations in paediatric patients. Methods: A retrospective study of 49 paediatric patients who underwent sclerotherapy from 1 June 2009 to 30 June 2015 was performed. Of the patients, 25 were male and 24 were female, with a mean age of 6.3 years (range, 2 months to 17 years). In all, 29 (59%) patients had venous malformation and 20 (41%) had lymphatic malformation. The location of lesions included 25 (51%) in the head and neck, 11 (22%) in the trunk, and 13 (27%) in the extremities. The outcomes of treatment were reviewed from electronic patient records. Results: A total of 98 sclerotherapy sessions were performed (mean, 2.0 sessions per patient; range, 1-8 sessions) by an interventional radiologist. Some procedures were performed in collaboration with paediatric surgeons, head and neck surgeons or ophthalmologists. The mean follow-up duration was 39.7 months (range, 1-75 months). The most commonly used sclerosants were sodium tetradecyl sulphate alone in 28 (39%) sessions, alcohol (ethanol) and lipiodol mixture in 24 (34%) sessions, and ethanolamine oleate in 10 (14%) sessions. For lymphatic malformations, doxycycline was used as the sclerosant in 27 (100%) sessions. General anaesthesia was administered in 85 (87%) sessions and local anaesthesia in 13 (13%). Among 46 patients, 35 (76%) reported a decrease in swelling and eight (17%) had complete resolution of symptoms. There were no major complications; 10 minor complications, including skin blistering and pneumonia, subsequently resolved. Conclusion: A multidisciplinary approach in treating low-flow vascular malformations can offer patients an optimal and individualised treatment plan. Percutaneous sclerotherapy is an effective and safe therapy for certain vascular malformation lesions in paediatric patients.