Research Presentation Session: Interventional Radiology

RPS 709 - Novel treatment options for malformations and benign tumours

February 29, 08:00 - 09:00 CET

7 min
Polidocanol sclerotherapy of venous malformations in children- efficacy, safety, and predictors of outcome and complications
Niclas Schmitt, Heidelberg / Germany
Author Block: N. Schmitt, J. Lorenz, S. Hohenstatt, F. Ruping, P. Günther, M. Bendszus, M. Möhlenbruch, D. F. Vollherbst; Heidelberg/DE
Purpose: Venous malformations (VMs) represent the most common type of congenital vascular malformations and feature a wide range in size, location, appearance, and clinical symptoms. Percutaneous sclerotherapy (PS) using polido-canol is an established treatment, aiming at an improvement of the clinical symptoms. The influence of patient- and disease-specific factors on treatment success and complications in children has not been systematically addressed so far.
Methods or Background: All children (<18 years) with VMs who were treated with PS using polidocanol between 01/2011 and 11/2021 in our institution were included. Demographics, clinical data and radiological features were analysed and the influence of patient- and VM-related factors on the outcome and complications according to the CIRSE classification were investigated.
Results or Findings: A total of 83 children were included with a symptom improvement in 54.0%, stable symptoms in 34.9%, and worsening in 11.1%. The overall complication rate was 13.3% with an absence of permanent complications. Complications were more frequently in children after the treatment of extremity-located VMs (p=0.01; complication rate 12.2% for VMs of the extremities and 1.6% for VMs in other locations). This suggests that VMs located along body parts with a more intense movement may increase the probability for periprocedural complications with a further impact by the increased venous pressure in the lower extremities. There was no significant factor affecting the clinical outcome with a tendency for a worse outcome in children suffering from VM-related swelling (p=0.11).
Conclusion: PS of VMs using polidocanol can be an effective treatment option in children with an acceptable safety profile. Complications can be more frequently expected for VMs of the extremities and should be considered for therapy planning.
Limitations: This was a retrospective single-centre analysis, which included a disproportionate incidence of head and neck VMs and assessed outcomes subjectively by the patients themselves.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Ethics Committee of the Medical Faculty at Heidelberg University.
7 min
Long-term outcomes of hand arteriovenous malformation management: single referral vascular anomalies centre over 25 years’ experience
Yong Deok Lee, Seoul / Korea, Republic of
Author Block: Y. D. Lee, S. Y. Lee, K. B. Park, D-I. Kim, S. S. Yang, Y. S. Do; Seoul/KR
Purpose: Hand arteriovenous malformations (AVMs) are extremely difficult to manage for their functional importance and cosmetic problems. A single centre retrospective study was conducted to identify long-term outcomes of multidisciplinary team management of hand AVM.
Methods or Background: Retrospective vascular anomalies centre data was reviewed from 1995 to 2022. Patient’s demographics, Schobinger’s AVM stage, sclerotherapy details, surgical history, and adverse events after sclerotherapy were reviewed.
Results or Findings: 150 hand AVM patients visited our hospital from 1995 to 2022. The mean age was 33 years (range, 1-75 years) and 91 of 150 were female. 44 were Schobinger stage II and 106 were stage III. 101 patients (67%) received a total of 319 sessions of percutaneous sclerotherapy. Angiographic devascularisation rates after sclerotherapy were as follows: 16 had 100% devascularisation, 30 had over 90% devascularisation, 34 showed 50-90% devascularisation, 15 showed 0-50% of devascularisation, and six showed aggravation. 123 of 319 of (39%) had sclerotherapy-related adverse events (112 were minor and 11 were major adverse events). 15 of 101 (15%) patients eventually received amputation surgery after mean 1618 days (range, 3-5444 days) after sclerotherapy (sclerotherapy-related necrosis (n=3) and delayed amputation (n=12)). 13 of 150 (9%) of patients received primary surgical amputation for ulcer or bleeding (all Schobinger stage 3). The remaining 36 patients (34%) followed without any procedure.
Conclusion: In our study, 67% of hand AVM patients (101/150) were initially treated with sclerotherapy and 9% of patients (13/150) by surgery. 80% of patients showed response to sclerotherapy (over 50% devascularisation rate) with a major complication rate of 7%. However, 15% of patients eventually received amputation surgery after sclerotherapy.
Limitations: The limitations of the study are its retrospective nature and single-centre experience.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Ethical approval was not sought for the present study because this was a retrospective observational study conducted at the Samsung Medical Centre.
7 min
Analysis of adverse events after peripheral arteriovenous malformation embolisation: single Korean referral vascular anomalies centre experience
Jiyoon Ban, Gangnam-gu, Seoul / Korea, Republic of
Author Block: J. Ban1, S. Y. Lee1, K. B. Park1, D-I. Kim1, S. S. Yang1, Y. S. Do2; 1Seoul/KR, 2Gyeonggi/KR
Purpose: Peripheral arteriovenous malformations (AVMs) are extremely difficult to manage for their functional importance and cosmetic problems. This single-centre retrospective study was conducted to identify factors that contribute to adverse events (AEs) after embolisation of AVMs using percutaneous sclerotherapy.
Methods or Background: A retrospective review of patients who underwent sclerotherapy of AVMs from 1997 to 2022 was performed. 1273 procedures in 444 patients (median age: 28.0 years; interquartile range: 18.0-38.0 years) were evaluated. The AVM characteristics and details of AEs were analysed. According to Society of Interventional Radiology guidelines, AEs were divided into minor and major. Univariate and multivariate analyses were performed to find factors associated with AEs.
Results or Findings: Ethanol (94.2% of procedures, mean 26.2ml per session) and coils (33.4% of procedures, mean 31.4 coils) were mainly used for sclerotherapy. Upper extremity AVMs were most common (39.6%), followed by lower extremity (33.9%), abdomen-pelvis (22.4%), and thorax and neck (4.1%). 297 of 1273 procedures (23.3%) had sclerotherapy-related adverse events (261 were minor and 36 were major adverse events). Skin damage and transient nerve injury were most frequent in AEs. Coil used OR, 0.3672; 95% CI, 0.2607-0.5172, P<0.0001), diffuse AVMs (OR, 0.6837; 95% CI, 0.5095-0.9174; P=0.0112), body AVMs (OR, 0.522; 95% CI, 0.3685-0.7393; P=0.0003), and skin non-involvement (OR, 0.5741; 95% CI, 0.4268-0.7721; P=0.0012) were negatively associated with AEs.
Conclusion: In our ethanol and coil based AVM sclerotherapy, 297 AEs were developed after 1273 sessions of AVM sclerotherapy (23.3%). Most AEs were minor. Use of coil, diffuse involvement, body AVM and skin non-involvement showed protective effect on AEs.
Limitations: Our study was limited to a single centre and based on retrospective review of previous procedures.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Ethical approval was not sought for the present study because this was a retrospective study conducted at Samsung Medical Center with an observational nature.
7 min
Ultrasound-guided ethanol ablation of medial and lateral neck cysts
Katya M Duvivier, Amsterdam / Netherlands
Author Block: K. M. Duvivier, C. Peeters, S. Eerenstein, P. De Graaf; Amsterdam/NL
Purpose: The purpose of this study was to evaluate the treatment effect, cosmetic aspects, and the quality of life (QOL) of ethanol ablation (EA) as a minimally invasive treatment of TGDC and BCC neck cysts.
Methods or Background: Between February 2022 and July 2022, 21 patients with either a TGDC or BCC neck cyst were prospectively included in this study. EA was performed in 21 patients. Treatment was performed following a standard protocol including ultrasound (US) guided cyst aspiration and rinsing with saline followed by injection of 96% ethanol. Patients received a questionnaire both before EA and after three months of follow-up. Therapeutic outcomes, including volume reduction ratio, therapeutic success rate, cosmetic results, and complications were evaluated.
Results or Findings: Twenty-one patients were included who underwent EA for TGDC (N=12, 57%) and BCC (N=9, 43%). The mean age was 41.1 years old (IQR:33.5-51.5) with 6 males (29%) and 15 females (71%). Of the 21 eligible patients, 20 completed the questionnaire pre-EA and post-EA. The mean volume of the cyst prior to treatment was 10.9cc (IQR: 17.01-2.79) and after EA- treatment was 1.20cc (IQR: 0.11-1.42), wich results in a mean volume reduction of 81.86% (IQR:83.50-98.00). Two patients required a second treatment. No significant complications occurred during follow-up. 89% (N=16/18) Of the patients show an overall improvement of the QOL. The VAS-score during the procedure had a mean of 1.4 (N=21) and after the procedure of 0.7 (N=21) on a 0-10 pain scale.
Conclusion: EA is an effective, safe, and minimally invasive method of treating TGDC and BCC neck cysts . The procedure is well tolerated and can be repeated, when necessary, without complications or hindering any surgery.
Limitations: The limitations of this current study are the small sample size and the short follow-up period.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.
7 min
Transarterial embolisation of renal angiomyolipomas: a prophylactic treatment for reducing myogenic components
Lorenzo Braccischi, Bologna / Italy
Author Block: L. Braccischi1, L. Bellini2, F. Modestino1, L. Bartalena1, M. C. Galaverni1, M. Renzulli1, A. Cappelli1, L. Bianchi1, C. Mosconi1; 1Bologna/IT, 2Rome/IT
Purpose: Renal angiomyolipomas (AMLs) are benign hamartomatous tumors containing elements of smooth muscle, fat and vascular tissue. 70% of all AMLs are sporadic and tend to be solitary. The most concerning complication of AMLs is the risk of bleeding which is linked to dimensions and can lead to retroperitoneal haemorrhage. Selective embolisation of the renal artery has been approved as a prophylactic treatment option. Nevertheless, there is still a lack of literature. The aim of this study was to evaluate the short and long-term efficacy of AML embolisation. The percentage of fat and myogenic component was calculated in each AML and compared in volume before and after the embolisation of each component was evaluated.
Methods or Background: A total of 26 AMLs were treated between May 2015 and February 2023. All lesions were completely embolised according to the angiographic criteria of vascular stasis and the absence of arterial feeders. Cyanoacrylate glue was the most commonly used embolic agent.
Results or Findings: The efficacy of embolisation was determined over a mean follow-up period of 30.5 months. Mean lesion size at diagnosis was 56.85mm with a pre-treatment mean percentage of myogenic component around 60%. Embolisation of the renal AMLs was technically successful for all 26 lesions. Long-term follow-ups showed a mean diametre reduction of 23.57mm with a 50% reduction in the volume of the myogenic component.
Conclusion: Transarterial embolisation is effective in reducing the volume of the myogenic component of AMLs, therefore lowering the chance of haemorrhagic events while preserving renal function. No major complications were observed demonstrating the highly safe profile of the procedure.
Limitations: This was a retrospective study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.

This session will not be streamed, nor will it be available on-demand!