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Home > Vascular Annual Meeting > markovic_initial_experience

Initial Experience in the Treatment of Low Flow Vascular Malformations with Sodium Tetradecyl Sulfate Foam Sclerotherapy

Jovan N. Markovic, Cynthia E.K. Shortell.
Duke University, Durham, N.C.

OBJECTIVES: Low flow vascular malformations (LFVMs) have been treated effectively with both ethanol sclerotherapy (ES) and polidocanol foam sclerotherapy. Given the major limitations associated with ES, and the lack of FDA approval for polidocanol in the United States, we sought to determine whether foam sclerotherapy (FS) with sodium tetradecyl sulfate (STS, Sotradecol®) was effective in the treatment of LFVMs.

METHODS: Over an 18 month period we prospectively followed patients treated for LFVMs. All received MRIs to rule out a high flow component. Treatment was provided by multidisciplinary team. Early in our experience, patients received either surgical resection or ethanol sclerotherapy (ES). ES was subsequently replaced by STS FS (Tessari method), using either visual or ultrasound guidance. Treatments were performed under local anesthesia, except in pediatric patients. Pretreatment goals were individually set for each patient. Successful accomplishment of these goals was used as criteria for completion of treatment and outcome assessments. Follow-up was done after each STS FS treatment. Surgical resection was used for encapsulated and microvascular lesions.

RESULTS: 4 males and 13 females, ranging in age from 9 months to 53 years (mean 22.5 years) were treated for LFVMs [Table 1]. 12 patients underwent treatment with STS FS. 11/12 (91.7%) had improvement. In 5/6 (83.3%) patients with completed STS FS we successfully achieved more than 85% of pretreatment goals. 5/6 (83.3%) patients with treatment in progress experienced improvement after the first STS FS. 2 patients underwent treatment with ES. Of the two patients receiving ES one had no benefit and one had minimal improvement. Both had complications (DVT, ulcer). Surgical resection and FS were associated with excellent results and no complications, while ES had significant complications.

CONCLUSIONS: Our preliminary findings in this small group of patients demonstrate that FS with STS is safe and may have effectiveness comparable to polidocanol. Compared to STS, sclerotherapy with ethanol is less effective and associated with a higher rate of complications.

AUTHOR DISCLOSURES: J.N. Markovic, None; C.E.K. Shortell, None.