Abstract No. 38: Sotradecyl sulfate foam sclerotherapy of venous malformation with upper airways or oropharyngeal compromise

To evaluate the safety and efficacy of sotradecy sulfate (STS) foam sclerotherapy in patients with symptomatic venous malformation (VM) involving the buccal, pharyngeal and laryngeal regions. A retrospective study of 24 patients (including 3 children) who had a symptomatic VM affecting either the cheek/masticator space; lips/chin; tongue/mouth's floor; larynx/epiglottis and the rhino/oropharynx for a total of 30 lesions. The main symptoms were pain, feeling of heaviness, mastication impairment, dyspnea, dysphonia and bleeding. Patients had sclerotherapy sessions under ultrasound and fluoroscopic guidance using 3% STS foam mixed with lipiodol and air. Clinical results were evaluated using the Manchester orofacial disability scale. If present, complications were reported according the SIR standards. Size reduction was evaluated by MRI using the mean of the three orthogonal diameters at base line and follow-up. Volumetric and perfusion changes were also generated in the same way. The post treatment quality of life was evaluated using the SF-36 questionnaire. A mean of (2,5±1,3) sessions per patient were performed with administration of a STS foam volume of (10,7± 7,0) cc. On imaging, consolidated lesions (n=19) had a mean size reduction of (28,5±34,7)%. A perfusion score reduction from (3,3±1,1) to (2,7±1,2) (p=0,06) was also observed. Volumetric measurements and the SF-36 questionnaire's results will be available for the presentation. Reduction of the Manchester Orofacial disability scale score was significant, from (8,0±5,6) to (2,5±5,4) (p= 0,005). Three episodes of minor mucosal ulceration (Grade A complication) were reported with no long-term complications and 3 patients with either laryngeal or pharyngeal involvement required tracheostomy (Grade D complication). One was installed preemptively and 2 post-operatively secondary to post-sclerotherapy edema; all were temporary. STS foam sclerotherapy of symptomatic VM involving the buccal, pharyngeal and laryngeal regions is safe and efficient. Depending on the localization, tracheostomy can be necessary to preserve airways from post-sclerotherapy edema and a close collaboration with the ENT team is required.