Efficacy and safety of foam sclerotherapy with sodium tetradecyl sulfate as the preferred sclerosant of venous malformations based on the experience from a single specialist center.

OBJECTIVES: To assess the efficacy and safety of interventional therapy of venous malformations (VM) with foam sclerotherapy as the treatment of choice based on the experience of a single specialist centre.

METHODS: All patients with VM who underwent interventional therapy i.e. EST and/or open surgery from January 1st , 2015 - December 31st , 2019 were identified through a prospective database. Types of venous malformation (VM) were classified according to Puig's classification. The outcome measures assessed included efficacy and complications. The former was divided into four groups: no response, mild response, moderate response, and complete response. Complications were defined as any tissue or functional damage, distal embolization or tissue reaction. Continuous variables were compared using analysis of variance (ANOVA) F test and discrete variables were analysed using Chi-squared tests. P<0.05 was considered significant.

RESULTS: A total of 207 patients were included. Puig type I lesions were significantly less likely to be treated with foam sclerotherapy using STS 3% (p=<0.001), and more likely surgically excised (p=<0.001). In the patient's first procedure during the study period, the volumes of foam STS 3% were significantly different across all types of VM (p=<0.001); patients with type I VM received less volume of STS 3% when compared to those with type II and III lesions. The efficacy outcome categories were significantly different across all types of VM (p=<0.001). Overall only 14 (6.8%) patients reported no improvement in efficacy, and 38 patients 38 (18%) patients did not attend follow-up. Therefore 154 (74.8%) patients achieved some form of efficacious outcome. Ten (4.8%) patients experienced complications such as hematoma, thrombophlebitis and ulceration. The proportions of complication were significantly different across the categories (p=0.030) with more complications reported in type I VM.

CONCLUSIONS: Interventional therapy with foam sclerotherapy using STS 3% is clinically effective and safe for patients with VM and was most successful among Puig's type I and II VM.