Percutaneous Sclerotherapy for Low-flow Vascular Malformations in Paediatric Patients: 6-Year Experience of a Multidisciplinary Team
ACW Lee, HS Fung, WL Poon, PCM Chan, MWY Leung, CSW Liu, D Luk, WY Cheung, KL Yuen, D Tang, PC Kwok, KW Tang
Hong Kong J Radiol 2018;21:16-24
DOI: 10.12809/hkjr1616441
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.
中文摘要
經皮硬化劑治療小兒低流量脈管畸形：一個多學科小組的六年經驗
李昭穎、馮漢盛、潘偉麟、陳志滿、梁偉業、廖思維、陸志剛、張永融、袁國禮、鄧立超、郭昶熹、鄧國穎
目的：香港伊利沙白醫院的血管異常診治多學科小組由多名專科醫生和護士組成，為血管異常的兒科患者提供一站式綜合處理。本研究旨在評估本中心以經皮硬化劑治療小兒低流量脈管畸形的有效性和安全性。
方法：納入2009年6月1日至2015年6月30日期間接受硬化劑治療的49名兒科患者為回溯研究對象，其中男性25例、女性24例，平均年齡6.3歲（介於2個月至17歲）。29例（59%）為靜脈畸形、20例（41%）為淋巴管畸形。病變部位包括頭頸部25例（51%）、軀幹11例（22%）和四肢13例（27%），並從患者電子病歷記錄中核對治療效果。
結果：由一位介入放射科醫生進行98次硬化劑治療（平均每名患者2.0次，介於1-8次），部分聯同小兒外科、頭頸外科或眼科醫生完成。平均隨訪期為39.7個月（介於1-75個月）。用於治療靜脈畸形的硬化劑包括十四烷基硫酸鈉（STS；28次〔39%〕）、酒精／碘油混合液24次（34%），以及乙
醇胺油酸酯10次（14%）。用於淋巴管畸形的硬化劑為強力黴素27次（100%）。進行全身麻醉共85例（87%），局部麻醉13例（13%）。46例中，35例（76%）腫脹減輕、8例（17%）完全緩解。所有患者均未出現嚴重併發症，只有10例出現包括皮膚起泡和肺炎的輕微併發症，及後全部消退。
結論：多學科方法治療低流量脈管畸形為患者提供最佳個性化治療方案。經皮硬化治療對某些脈管畸形病變的兒科患者來說是有效和安全的。