Management of low flow venous malformations using sclerotherapy: A randomized controlled trial.

Background: Vascular malformations are structural irregularities of the blood vessels, which occur during vasculogenesis, angiogenesis, and lymphangiogenesis. Venous malformations (VMs) are common vascular malformations that may be located in any region of the body, with a preference for head and neck. Low-flow vascular malformations (LFVM) include venous, capillary, and lymphatic forms and are present at birth.Aim: The work aimed to compare the success rate of different sclerosing agents (ethanol, cyanoacrylate, and polidocanol foam) used in the treatment of LFVM.Patients and Methods: This computer based randomized prospective comparative study was conducted on 60 patients suffering from LFVM, admitted to the vascular surgery department in Mansura University Hospitals (MUH) from September 2019 to September 2021.Results: A total of 60 patients were treated by sclerotherapy using ethanol (n=20 patients), polidocanol (n=20 patients), and cyanoacrylate (n=20 patients). A total of 182 sclerotherapy sessions were performed (range, 1-4 sessions for each lesion) with mean of two sessions for every lesion. Follow-up of lesions was done after injection for incidence of cure, complications, and need for surgery. There was a statistically significant difference between the three studied groups as regard follows-up of lesions after injection, where ethanol group cases had more complete cure (55%) followed by cyanoacrylate group (50%) and there was a statistically significant difference considering complications after sclerotherapy where the majority of Polidocanol group cases had no complication (70%). In cyanoacrylate group, 40% of cases need surgery to excise a remnant solid mass.Conclusion: Sclerotherapy is effective for the treatment of LFVM. Polidocanol is a safer sclerosing agent compared with ethanol and Cyanoacrylate. Ethanol was associated with a better cure rate than polidocanol and Cyanoacrylate. Cyanoacrylate was associated with a sufficient cure rate but complicated by hard mass so better to be used before surgical excision.