Percutaneous Sclerotherapy for Vascular Malformations: A Systematic Review

Background: This systematic review assessed the available published evidence on the safety and efficacy of percutaneous sclerotherapy for patients with congenital vascular malformations. Methods: A systematic search of various electronic bibliographic databases was conducted in May 2013. A grey literature search was also performed. Study selection, data extraction, and assessment of study quality were undertaken by one reviewer and checked by another reviewer. Results: One systematic review, one randomized controlled trial, one nonrandomized controlled trial, and 24 case series studies were included. However, deficiencies in reporting, small sample sizes, and marked inter-study heterogeneity precluded a definitive synthesis of the data. Ethanol sclerotherapy appeared to be potentially effective in treating venous malformations, with the majority of patients achieving some lesion regression. However, it is associated with a 16% risk of major complications, including deep tissue injury, deep vein thrombosis, and nerve injury. While there was limited evidence that sclerotherapy with OK-432 was an effective treatment for lymphatic malformations, evidence for the use of sclerotherapy in patients with arteriovenous malformations was unclear. Conclusions: Very limited evidence from case series studies suggested that sclerotherapy with ethanol and OK-432, administered over multiple sessions, was effective in the treatment of venous and lymphatic malformations, respectively. However, the value of percutaneous sclerotherapy as a pretreatment for or an alternative to surgery is not known. Further evidence is required to delineate which patients will benefit most from percutaneous sclerotherapy to ensure that the advantages of treatment will outweigh the risks.