Retrospective Study On Sclerotherapy Of Pure Ethanol Combined With Bleomycin For Venous Malformation

BackgroundVenous malformation(VMs)are the most common vascular malformation.Although there are various options in the treatment of VMs,sclerotherapy is generally accepted as the major therapeutic tool in the world.Sclerotherapy is using various sclerosants to destroy the vascular endothelial cells of the lesions,leading to inflammation and thrombosis in the vessels,resulting in fibrosis of abnormal vein channels and atrophy of the lesions,so as to achieve therapeutic purposes.There are many differences reported in clinical effects and complications of sclerosants.There is no standardized therapeutic algorithm has yet been identified for management of VMs.This study is a retrospective analysis.we reviewed the 28 patients with venous malformations who underwent 54 cases of the combination of pure ethanol and bleomycin sclerotherapy to evaluate the efficacy and safety in the treatment of venous malformations and to investigate the appropriate treatment strategy.ObsjectiveTo investigate the clinical outcomes and their predictors such as clinical classification and the concrete therapeutic method in patients with VMs treated with the combination of pure ethanol and bleomycin sclerotherapy,and to provide evidence for the standardized guidelines for VMs.MethodsWe retrospectively evaluated clinical outcomes of the combination of pure ethanol and bleomycin sclerotherapy in 26 patients with 54 cases from the department of plastic surgery,Changhai Hospital of Naval Military Medical University from June 2014 to December 2018 to access reduction in mass volume after treatment.Fisher exact test was used to determine the statistical differences among the groups.Univariate was performed to determine possible predictors of clinical outcome.GAMM was fitted to access the associations between these predictors and mass volume.Results1.A total of 54 sclerotherapy cases were performed in 26 patients with VMs.Based on imagine studies,26 patients(84.62%)had effective result,and 11 patients(42.31%)were cured.29 cases(53.70%)had effective result,and 10 ceses(18.52%)were cured.2.Cure rate was significantly associated with size of lesion diameter(P <0.001),but not with the lesion invasive depth(P =0.419).Effective rate was not different between size of lesion diameter and lesion invasive depth(P =0.598,P =0.591).3.Univariate Logistic analysis for positive response showed that the cure rate of patients was significantly associated with lesion location,size,number of sclerotherapy,total amount of bleomycin and amount of per unit volume of pure ethanol and bleomycin(P<0.05).The effective rate of patients was significantly associated with no factor(P>0.05).4.We used the generalized additive mixed model(GAMM)and discovered that lesion size and amount of per unit volume of pure ethanol and bleomycin were significantly associated with the proportion of lesion volume after every sclerotherapy.On multivariate analysis,number of sclerotherapy was independent predictors of the proportion of lesion volume.number of sclerotherapy,the ratio of pure ethanol to bleomycin were significantly associated with the lesion volume after every sclerotherapy.On multivariate analysis,number of sclerotherapy was independent predictors of lesion volume.ConclusionsPure ethanol combined with bleomycin is effective in the sclerotherapy of venous malformations.Lesions with smaller diameter had better therapeutic effect,and the depth of invasion had no significant effect on the therapeutic effect.The treatment effect could be enhanced when we increased the dosage of pure ethanol and bleomycin per unit volume,and the dosage of bleomycin in case of the dosage of pure ethanol were equal.Number of treatments is an independent predictor for single treatment effect.Repeated treatment with long-term and regular sclerotherapy can improve the treatment effect.