Several studies have shown that sclerotherapy for intramuscular hemangioma is an effective treatment. In addition, it has also been shown to be a cost-effective procedure. However, it has not been proven that this procedure is a good option for all patients. It is important to note that not all hemangioma patients can be treated with sclerotherapy. In order to determine if sclerotherapy is the best treatment for your hemangioma, you must consult with your physician.
Percutaneous sclerotherapy
During surgery, blood clots may form in the vessel. Sclerotherapy is a treatment option that is used to obliterate the blood clot. This may also be used to control bleeding during surgery.
Injection of a sclerosing agent is another option. It causes collagen fiber shrinkage and exfoliation of endothelial cells. Sclerotherapy may be used for large diffuse hemangiomas. A sclerosing agent is selected according to the location of the lesion. The amount of sclerosant injected per session may vary. This will depend on the flow rate and experience of the interventional physician.
The treatment of an IH requires careful attention to the location and size of the lesion. The most common site is the lower extremities, with plantar IH being the most common type. However, the occurrence of IHs is widespread and is common in young adults before the third decade of life.
In this study, we evaluated the efficacy of sclerotherapy for intramuscular hemangioma (IVM). The study consisted of 50 patients who underwent sclerotherapy treatment for IVM between 2008 and 2016. The study procedures were in accordance with institutional guidelines for human experimentation.
The study was conducted in the Department of Otolaryngology at the VMMC. The patients were male and female. They ranged in age from 18 to 62 years. The study excluded patients with low-flow vascular malformations, Klippel-Trenaunay syndrome, and malignant transformations.
The main efficacy end point was reduction in size after treatment. The amount of sclerotherapy per session was 2 to 15 units. Injection was performed with a 20-G x 51-mm catheter. Sometimes, the second volume of sclerotherapy was injected faster. A pink aspirate was obtained and the noncompressibility of the injected zones was evaluated.
Clinical follow-up was similar for the clinical outcome groups. The median duration between the last sclerotherapy session and MR follow-up was 42 days. The recurrence rate was 18 to 61%. The exclusions were due to patient nonattendance and lack of MR follow-up.
The authors concluded that sclerotherapy is effective for the treatment of IHs and is an alternative treatment option. It can reduce the size of the IH, reduce the location of the lesion, and can prevent extensive surgical modalities.
Bleomycin
Several studies have shown the effectiveness of bleomycin in sclerotherapy for intramuscular hemangioma. Although, the optimal dose of bleomycin remains unclear, it has shown lower adverse event rates compared to other sclerosing agents. Moreover, bleomycin shows a higher sclerosing effect on the vascular endothelium.
In this study, the effect of percutaneous sclerotherapy with bleomycin and ethiodized oil on low flow vascular malformations was evaluated. The study was a retrospective follow-up study that evaluated patient perceptions of changes in various health aspects. The Global Rating of Change (GRC) domains used to measure the outcome of bleomycin sclerotherapy were overall health status, pain, and emotional well-being. In addition, the patients were asked to rate their overall severity of symptoms and their social, work, and physical well-being. Afterward, they were asked to fill in an online questionnaire. This questionnaire was developed by SurveyMonkey Inc in San Mateo, California, USA.
Patients were selected to participate in the study through a prescription database of hospital pharmacies. The following characteristics were considered for inclusion: (a) symptomatic GLH; (b) no prior hepatic impairment; and (c) no other diagnoses other than low-flow vascular malformations.
Bleomycin and ethiodized oils were mixed in a volume of 10 mL. The mixture was then injected into the lesion under fluoroscopic guidance. The amount of bleomycin injected depended on the size of the lesion. The volume of the lesion was reduced by more than 50% after the first session of intervention. Nevertheless, the second session was not considered in the protocol if the volume of the lesion was not decreased adequately.
The hemangioma in the head and neck region is the most common malformation in infants. Although, the rate of growth of hemangiomas in the first three days of life is only 1.1%, it increases to 2.6% in the first year. In this study, the mean preoperative visual analog scale score was 856.3 cm3 and decreased to 206.0 cm3 after sclerotherapy.
The Global Rating of Change (GRC) scales ranged from -3 (worst possible deterioration) to +3 (best possible improvement). The overall severity of symptoms was rated against social activities, work-related activities, and emotional well-being. The mean pain score decreased by 63.5% and the overall severity of symptoms decreased by 83% at 5 months of follow-up.
Ethanol
Using ethanol sclerotherapy to treat intramuscular hemangioma is not a new idea. However, the use of this technique for outpatient treatment of vascular lesions has been less well documented. This study describes the results of using this technique in the treatment of venous malformations.
Thirteen patients underwent ethanol sclerotherapy of hemangiomas. The median age of the patients was 21 years. A total of 30 injection procedures were performed. The amount of ethanol injected ranged from 0.8 to 40 ml. There was minimal blood loss during the procedure. Injections were performed under general anesthesia, except for one patient.
Ethanol was the most commonly used sclerosant in this study. The rate of success was higher with ethanol than with the other three sclerosants. The rate of recurrence was also lower with ethanol. However, it was not statistically significant. The success rate was 60% for ethanol, compared with 3% STS and 29% for bleomycin.
After treatment with ethanol, the size of the VM decreased significantly. There was decreased pain and symptoms. The total size of the VM was reduced to about 2.5 cm. In some cases, the VM was completely confined. In other cases, the VM had extensive involvement of the extremity.
The main symptom was pain. Pain was relieved in approximately half of the treated VMs. However, the VMs did not heal completely. Skin ulceration was a common complication. However, it was managed by wound care. Approximately half of the VMs developed blister formation. This was easily managed with local debridement.
In total, 27 complications were reported. These complications were divided into eight major complications and 19 minor complications. Overall, the recurrence rate was 30%. A total of 13 patients were not successful in the sclerotherapy. Of these, one patient was readmitted 5 months later for removal of an infected hip prosthesis. Another patient suffered from massive intravascular hemolysis.
A venogram was obtained in all patients before treatment. This was performed to determine the size of the VM and to delineate the deep venous system. In the early series, venograms were performed routinely. However, most patients now undergo MRI only.
MR imaging
MRI is a powerful diagnostic tool for intramuscular hemangioma (IH). It is important to note that IH is a benign tumor of soft tissue. It usually presents with swelling, pain, and an enlargement in the affected site. It is often present at an early age, and may be associated with growth spurts. In some cases, it may recur in later life.
In most cases, an accurate clinical history is important for making a correct diagnosis. In some cases, haemangiomas are mistaken for vascular malformations (VMs), a benign tumor of venous and arterial blood vessels. This can cause considerable discomfort and morbidity.
MRI is a very useful imaging tool for VMs. It is used to obtain both static and dynamic views of the lesions. It is especially helpful in determining treatment pathways for VMs. There are several classification systems that are based on the use of MRI. These systems link the size, definition, and treatment of the lesion to an ideal treatment.
Various classification systems have been developed to aid in the diagnosis of VMs. The ISSVA classification divides vascular anomalies into two main groups, infantile and congenital. In a study by Wild et al., five of the eleven haemangiomas that were investigated were found to be congenital, whereas the remaining four were infantile.
The TRICKS technique is another imaging tool that is becoming very popular. It allows for time-resolved imaging of contrast kinetics. It has been shown to be effective in many studies.
MRI and DPP are essential tools in the diagnosis of VMs. MRI can show changes in the size, vascularization, and morphology of the lesion. DPP plays a key role in determining the treatment pathway for VMs. It is also useful for evaluating post-treatment outcomes.
In some cases, angiography is also an important imaging tool. Conventional magnetic resonance angiography techniques have limited indirect information about blood flow. They also may have long acquisition times. However, this can be improved with dynamic contrast MR angiography. This increases specificity to 95%.
When a patient has intramuscular hemangioma, it may be difficult to diagnose. Sclerotherapy is an option when excision is not possible.