Exploring the Properties and Preparation of Ethyl Cellulose−Ethanol Gel Sclerotherapy for the Treatment of Vascular Malformations following the 3R Principle

Vascular malformations, including arteriovenous malformations (AVMs), venous malformations (VMs), and lymphatic malformations (LMs), carry a risk of rupture, bleeding, and significant morbidity. AVMs are high-flow lesions associated with abnormal shunting between arteries and veins, while VMs and LMs are low-flow malformations characterized by dilated venous or lymphatic channels. Current therapeutic options are limited, which often results in mental health issues and diminished quality of life, particularly in younger patients. Sclerotherapy with ethanol-based agents is an effective minimally invasive treatment, particularly for low-flow lesions. Injectable ethyl cellulose-based gels containing ethanol have emerged as a potential treatment for sclerosing these abnormal vessels; however, their exact mechanism of action and behavior within the vasculature remain inadequately understood. Comprehensive knowledge of the therapeutic mechanism is crucial for optimizing its clinical application and achieving the best treatment outcomes. In this study, we explored the production process, stability, and intravascular behavior of ethanol-based gels, providing essential information for clinical practice and patient care. We developed an injection model to elucidate the physical properties and dynamics of the gel under flow conditions in vitro and within blood vessels in ovo. Our results demonstrate an effective and safe injection, showing limited adverse effects. These insights contribute to advancing injectable polymer-based gel formulations, offering improved options for treating vascular malformations.