Discussion On Therapeutic Evaluation Method Of Sclerotherapy For Limb Venous Malformations

PURPOSE: To discuss how to evaluate the effect of percutaneous sclerotherapy for limb venous malformations and guide the clinical treatment according to the results of the evaluation.MATERIALS AND METHODS: Thirty-eight patients with limb venous malformations treated with percutaneous sclerotherapy of 2011.1.1-2016.12.31 in the First Affiliated Hospital of Fujian Medical University were collected and analyzed.Inclusion criteria: 1.Diagnosed with limb venous malformations.2.Patients with signs or symptoms.3.Treatment with sclerotherapy.4.Patients had pre-and post-treatment Doppler ultrasound and magnetic resonance imaging.Exclusion criteria: 1.Digital subtraction angiography and Doppler ultrasound found with arterial malformations,arteriovenous malformation,lymphatic malformations,capillary malformation or combined vascular malformations.2.Patients without signs and symptoms.3.Patients treated without percutaneous sclerotherapy,such as surgical treatment,etc.4.Only Doppler ultrasound or magnetic resonance imaging review or both were not reviewed.To evaluate the effect of treatment by clinical manifestations(Grade I: no improvement in symptoms and signs;Class II: pain,numbness,swell slightly relieved or disfuntion slightly improved or pigmentation slightly improved.Class III: pain,numbness,swelling reduced up to the degree of tolerance,functional recovery to normal daily life or skin pigmentation improved significantly but not be completely normal.Grade IV: no pain,numbness,swelling,no dysfunction,skin pigmentation returned to normal)and objective imaging(evaluate narrow scope of the degree by Doppler ultrasound or magnetic resonance imaging,I level: ?25% or increase II grade: 26-50%,III: 51-75%,IV: 76-100%).To consistency test according to the evaluation results(KAPPA test).RESULTS: Thirty-eight patients were treat by percutaneous sclerotherapy of 1-12 times(average 4.1 times),were followed up for 1-60 months(average 12.5 months).In terms of safety,No one had serious complications of pulmonary embolism,pulmonary fibrosis or limbs necrosis.There is transient pain,swelling or numbness in patients,which was relieved in a few days to one mouth.In terms of effectiveness,they were evaluated by the degree of improving clinical manifestations.The results were divided into grade IV: 19 patients(50%),III: 12 patients(31.5%),II: 6 patients(15.8%),I: 1 patients(2.6%);Evaluated by color Doppler ultrasound,the results were divided into IV 13(34.2%),III 16(42.1%),II 7(18.4%),I 2(5.3%);Evaluated by MRI,the results were divided into IV: 4 patients(10.5%),III: 13 patients(34.2%),II : 15 patients(39.5%),I: 6 patients(15.8%).The rate of grade IV evaluated by clinical manifestations is significantly higher than Doppler ultrasound and MRI.The KAPPA between clinical manifestations and Doppler ultrasound was 0.684(P<0.05).The KAPPA between clinical manifestations and MRI was 0.217(P<0.05).The KAPPA between Doppler ultrasound and MRI was 0.323(P<0.05).CONCLUSIONS: 1.Percutaneous sclerotherapy is a safe and effective method for the treatment of limb venous malformations and the improvement of clinical manifestations is one of the most important follow-up methods in the therapeutic evaluation.2.The consistency of Doppler ultrasound evaluation and clinical manifestations is relatively good,and Doppler ultrasound can judge the blood flow signal,can be used as the first choice for imaging follow-up.3.The consistency of magnetic resonance imaging and clinical manifestations is relatively poor,but magnetic resonance imaging can clearly display the relationship between the lesion and the surrounding tissue,it is recommended as a secondary choice for imaging follow-up.4 The follow-up of the treatment of limb venous malformations should be combined with clinical manifestations,Doppler ultrasound and magnetic resonance imaging.