Malformações vasculares de baixo fluxo: resultados da escleroterapia ecoguiada com espuma de polidocanol 1%

Abstract

Introduction: Vascular malformations are congenital lesions, which occur due to an erroneous vascular development of the blood and lymphatic vessels during embryogenesis and can be present in any part of the body. They are a rare disease and the treatment is still controversial. Purpose: To assess the efficacy and safety of ultrasound-guided 1% polidocanol foam sclerotherapy of low flow vascular malformations. Methods: Prospective cohort study of symptomatic low flow vascular malformation in patients treated in Hospital das Clínicas da UFMG, between December 2016 and November 2018. Lesions were classified according to the location, extension, size, type of vessels, shape e symptoms. Patients were submitted to Short-form 6 dimensions (SF-6D) questionnaire of quality of life and lesion photography. Treatment was done through 1% polidocanol foam injection, and the maximum volume of foam was 10 ml at each session. It was made an assessment to the improvement of the symptoms with analogic visual scale and the presence of complications. The SF-6D questionnaire was applied again at the end of the treatment. Follow up was done each 3 months after the treatment. Results: 40 lesions in 38 patients were enrolled, being 19 male. Age ranged from 4 months to 63 years. The minimum time of follow up was of 2 months and the maximum was 23 months, with a media of 13 months. Most lesions (80%) were venous. The most common locations were lower limbs (47,5%), followed by upper limbs (22,5%) and head (17,5%). Regarding the extension, 27,5% were superficial, 35% were deep lesions and 37,5% affected both compartments. The most common clinical presentation was deformity (95%), followed by pain (77,5%) and functional limitation (57,5%). In terms of size, 52,5% of the lesions were bigger than 10 cm. The functional limitations were more often in lesions affecting the deep compartment (69%) compared to the superficial ones (27%, p=0,030). The psychosocial disturbs were less common for those lesions up to 5 cm (p=0,038) and for limited lesions (p=0,015). There was a significant improvement of all symptoms (p<0,001), and pain was the symptom that had the best and quickest response. Lesions bigger than 10 cm were associated with poor response in deformity (p=0,003). There was an improvement in quality of life in most patients (60%) and treatment satisfaction was high (82%). The most common complications were pain and local edema, without major complications. There was recurrence of the symptoms in a small part of the patients (15% recurred in pain, 10% in deformity and 12% in functional limitation). Conclusion: Low flow vascular malformations treatment using 1% polidocanol foam is effective and safe. It improves symptoms and quality of life, achieving high patient´s satisfaction scores. A small percentage of patients presented recurrence of the symptoms, being necessary to redo the treatment in order to maintain the improvements.