Outcomes of direct and endovascular embolo-sclerotherapy of high and low flow congenital vascular malformations

Background:Vascular malformations (VMs) are congenital anomalies resulting from aberrant vascular development.Unlike hemangiomas,VMs persist throughout life and may involve superficial or deep tissues, leading to significant clinical and cosmetic morbidity.Endovascular embolo-sclerotherapy offers a minimally invasive alternative for treating these lesions, aiming to occlude abnormal vessels while preserving surrounding tissue. Methods:This prospective study included 40 patients with extracranial congenital vascular malformations, confirmed by duplex ultrasound and MRI or CT angiography. Patients presented with pain,functional impairment, or cosmetic disfigurement. Sclerotherapy was performed using agents such as bleomycin, polidocanol,ethanol,or NBCA,selected according to malformation type and flow characteristics. Both low-flow (venous and lymphatic malformations) and high-flow (arteriovenous malformations) were treated using image-guided techniques. Patients were followed up clinically and radiologically, with outcomes assessed by symptom improvement and ultrasound-based grading. Results:The median patient age was 15.5 years, with a female predominance (75%).Venous malformations accounted for 72.5% of cases, followed by lymphatic(17.5%)and arteriovenous malformations (15%). The most common presenting complaint was disfigurement (92.5%), followed by pain (37.5%). Bleomycin was the most used agent (87.5%). Most patients required multiple sessions (median 2.75). Post-treatment complications were minimal, with pigmentation (10%) and thrombophlebitis (7.5%)being most frequent. On follow-up ultrasound, 75% of patients achieved complete resolution (Grade 1), and 25% showed partial response (Grade 2).No cases showed treatment failure (Grade 3). Conclusion:Endovascular embolo-sclerotherapy is a safe and effective treatment modality for vascular malformations.It significantly improves cosmetic appearance and alleviates symptoms with minimal complications.The procedure’s versatility makes it suitable for managing both low- and high-flow lesions,supporting its wider application in clinical practice.