Lim, CS; Evans, N; Kaur, I; Papadopoulou, A; Khalifa, M; Tsui, J; Hamilton, G; Lim, CS; Evans, N; Kaur, I; Papadopoulou, A; Khalifa, M; Tsui, J; Hamilton, G; Brookes, J; - view fewer (2020) Incidence of Major Complication Following Embolo-Sclerotherapy for Upper and Lower Extremity Vascular Malformations. Vascular (In press).

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Abstract

Purpose: The current literature on the major complications of embolo-sclerotherapy (EST) of upper and lower extremity vascular malformations (VMs) is scarce. Evaluating and understanding the rates and types of potential major complications of EST of VMs help treatment planning and informed consent. Therefore, this study reviewed major complications following EST of all upper and lower extremity VMs in a single single specialized multidisciplinary VM center over a 5-year period. / Methods All patients with VMs underwent multidisciplinary directed intervention. Demographic, procedural, follow-up and complication data were collected prospectively in a dedicated database, and reviewed retrospectively. Major complications for upper and lower extremity VMs from January 1, 2013 to December 31, 2017 were analyzed. All ESTs of high-flow vascular malformations (HFVMs) were performed under selective catheter angiography and direct injection, but low-flow vascular malformations (LFVM) with direct injection only. Major complications were defined as any tissue or functional damage caused by direct injection, distal embolization or tissue reaction. / Results Seventy patients (median age of 25 years; 44 males and 26 females) had 150 EST procedures for upper extremity VM. Of these, 28 patients had EST for HFVM and 42 patients for LFVM; total 78 and 72 procedures, respectively. A total of 107 patients (median age of 26 years; 42 males and 65 females) had 160 EST interventions for lower extremity VMs. Of these, 18 patients had EST for HFVM and 89 patients for LFVM; total of 30 and 130 procedures, respectively. The overall major complication rates following EST of upper and lower extremity VMs were 14.3% and 4.7%, respectively (P=0.030). In the upper extremity HFVM group, major complications from EST occurred in 5 patients; 3 ischemic fingers requiring amputation and 2 skin ulcerations. Meanwhile, in the upper extremity LFVM group, major complications occurred in 5 patients; 1 median nerve injury requiring nerve grafting and hand therapy, 1 hand contracture requiring tendon release, and 3 skin ulcerations. There was only one major complication which was cellulitis in the lower extremity HFVM group. In the lower extremity LFVM group, major complications occurred in 4 patients; 2 skin ulcerations, 1 cellulitis and 1 deep vein thrombosis. / Conclusions: EST is relatively safe for upper and lower extremity VMs in a high-volume experienced center where our major complication rates were 14.3% and 4.7%, respectively which compare favorably or similar to those reported in most recent literature. These outcomes will direct treatment strategies to avoid local and systemic toxic complications in the upper and and lower extremity, for both HFVM and LFVM, and to improve informed consent.

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